Hepatitis B: Should I Take Antiviral Medicine for Chronic Hepatitis B?

 

Hepatitis B: Should I Take Antiviral Medicine for Chronic Hepatitis B?

You can use it to talk with your doctor or loved ones about your decision.

1. Get the facts
2. Compare your options
3. What matters most to you?
4. Where are you leaning now?
5. What else do you need to make your decision?

1. Get the Facts

Your options

• Take antiviral medicine for chronic hepatitis B.
• Don't take antiviral medicine. Have regular blood tests and maybe a liver biopsy to check for liver problems.

If you have used antiviral medicine once without success or have had a relapse after treatment, your choices are different, and this information does not apply to you. Talk with your doctor to decide what is right for you.

Key points to remember

• Most people with chronic (long-term) hepatitis B don't develop serious problems and can live active, full lives without treatment. But some people may develop severe liver damage. If this happens, you may need a liver transplant.
• Treatment may not be an option for everyone who has hepatitis B, because antiviral medicines cost a lot and don't work for everyone.
• Experts recommend antiviral medicines if you have high levels of both the hepatitis B virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
• Antiviral medicines that stop or slow the growth of the hepatitis B virus can have serious side effects. Some people stop taking their medicines because they feel too sick to finish them.
• You may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and a biopsy shows no signs of liver damage.
• People who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some antiviral medicines.
• You will probably need to take medicine for many years. And you'll need to have regular exams and blood tests to see if the virus is still active in your body and to find out how well your liver is working.

FAQs

What is chronic hepatitis B?

You have chronic hepatitis B when the virus is active in your body for more than 6 months. The virus can damage liver cells and cause your liver to become swollen and tender.

Most people who have chronic hepatitis B don't have symptoms. But they can still pass the infection to other people, especially the people they live with or have sex with, unless they receive treatment that gets rid of the virus.

Most people with chronic hepatitis B don't develop serious problems. But about 15 to 25 people out of 100 who have the infection will die of cirrhosis or liver cancer.¹ When there is a lot of the virus in your body, your chance of having these problems is greater. Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

What medicines are used to treat chronic hepatitis B?

There are several antiviral medicines that can be used to treat chronic hepatitis B. They are sorted into two groups:

• Interferons, such as interferon alfa-2b and peginterferon alfa-2a. Interferons are given as a shot 1 to 3 times a week for 4 to 12 months.
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, entecavir, lamivudine, telbivudine, and tenofovir. NRTIs are taken as a pill once a day for at least a year, and usually for many years.

When you take interferons, you are less likely to relapse after you stop taking the medicine than if you took NRTIs. But fewer people are helped by interferons than by NRTIs.²

Experts recommend antiviral medicines if you have high levels of both the hepatitis B virus and liver enzymes in your blood for at least 6 months or if you have liver disease.

But antiviral medicines are not for everyone. The medicines can be helpful if you have or are likely to get liver damage, such as cirrhosis. But they may not help if you already have severe liver damage. People who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some of these medicines.

You may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and if your liver isn't damaged. Your doctor may remove a tiny piece (biopsy) of your liver to see if it has been affected by the virus.

Results from your blood tests can help you and your doctor decide which treatment might work best for you or if you need to take any medicine at all. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups to watch for liver problems.

How well do antiviral medicines work?

Antiviral medicines can stop or slow the growth of the hepatitis B virus and help prevent serious liver problems.

Interferon stops the growth of the hepatitis B virus over the long term in about 35 out of 100 people.² This means that it doesn't stop the virus in about 65 out of 100 people. Recent studies suggest that peginterferon works a little better than interferon.^{3, 4}

NRTIs slow the growth of the hepatitis B virus in your body. Studies show that lamivudine and adefovir can reduce liver damage in about half of the people who take these medicines.^{2, 5, 6} Entecavir can greatly reduce liver swelling and scarring. Tenofovir is effective at reducing the amount of hepatitis B virus in the body.⁷ Some studies show that entecavir works better than lamivudine or adefovir.^{8, 9, 10} Tenofovir works better than adefovir against hepatitis B virus that is resistant to lamivudine.¹¹

What are the side effects of antiviral medicines?

Antiviral medicines can have serious side effects that may cause problems throughout your treatment. Some people are not bothered by the side effects, while others stop taking their medicines because they feel too sick to finish them.

If you take interferons, you're more likely to have side effects than if you take NRTIs.

Side effects of interferons include:

• Fever.
• Headaches.
• Hair loss.
• Depression, which can be severe.

In rare cases, interferons can cause confusion and might affect your heart, thyroid, or kidneys.

NRTIs rarely cause problems. But side effects may include:

• Fever.
• Sore throat.
• Diarrhea.
• Headaches.
• Fatigue.
• Weakness.
• Dizziness.
• Stomach or back pain.

In rare cases, NRTIs have caused severe liver problems or a buildup of acid in the blood.

After any kind of treatment for hepatitis B, there is a chance that the virus will come back after you've stopped treatment.

The virus may also become resistant to the drug that you're taking. This means that the medicine no longer works to stop or slow the virus. If this happens, you may have to try another medicine. Drug resistance is more likely with some NRTIs.

Why might your doctor recommend antiviral medicines?

Your doctor might recommend antiviral medicines if:

• You have hepatitis B antigens in your blood.
• You have high levels of the virus in your blood.
• Your liver enzymes are more than twice the normal amount.
• You have liver disease.

2. Compare your options

	Take antiviral medicine	Don't take antiviral medicine
What is usually involved?	You take shots or pills for months or for many years. You have regular exams and blood tests to check for liver problems.	You have regular exams and blood tests to check for liver problems. You can take steps to prevent further liver damage by not drinking alcohol or using illegal drugs.
What are the benefits?	Antiviral medicines can stop or slow the growth of the hepatitis B virus. They can help prevent serious liver problems.	You avoid the side effects of antiviral medicines. You avoid the cost of antiviral medicines.
What are the risks and side effects?	Possible side effects include fever, headaches, diarrhea, hair loss, and depression. In rare cases, antiviral medicines may affect your heart, thyroid, kidneys, or liver. Or they may cause a buildup of acid in your blood.	If the hepatitis B virus is active in your body, you may: Get severe liver disease or liver cancer. Spread the infection to others.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Hepatitis B.

Personal stories about using antiviral therapy for hepatitis B

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My doctor says I have a good chance of doing well on interferon. My HBV DNA test showed that I have a pretty low level of the virus in my body. And my blood tests showed that my liver enzymes are high. Those factors mean I might do well on the medicine. And I guess women have better success than men, so that's another thing in my favor. I'm not wild about giving myself shots, but I'd rather do that than have major liver damage."

— Barbara, age 45

"I found out a couple of years ago that I have hepatitis B. I thought about taking any medicine I could to help my liver. But so far, my tests show that my liver is in good shape. My liver enzyme levels are normal, even though I still have the virus in my body. It might not do me any good to take medicines yet. I'll have my liver checked regularly, and if things change, I'll reconsider."

— Phil, age 28

"I've got diabetes as well as infection with hepatitis B virus. That means my immune system may not be as strong as it could be, so interferon may not help me much. But some people do really well on entecavir. I also like the fact that I can take it as a pill and do not have to have shots."

— Jamal, age 34

"I just found out I'm infected with the hepatitis B virus. My symptoms weren't bad, just a little nausea. My liver enzymes are up a little, but so far there is no evidence I have any serious damage to my liver. It can take a while to develop that, and since I'm older, it could be years away. I think I'll just keep an eye on it and visit my doctor for checkups."

— Teresa, age 55