Therapy for hepatitis B

introduction

Hepatitis B is a viral infection of the liver with the hepatitis B virus. In 90% of cases, such an infection heals spontaneously without therapy. In the following you will learn more about the special therapy for hepatitis B infection.

How is hepatitis B infection treated?

In most cases, therapy for an acute hepatitis B infection is not necessary as a complete cure can be expected in 90%. A light diet, bed rest, and general hygiene measures to protect the area from infection are the general therapeutic measures.

In the event of a chronic infection with the hepatitis B virus, some antiviral drugs, so-called virus statics, are now available. Antiviral therapy is indicated depending on the stage of the hepatitis B disease and virus activity.

Therapy of acute hepatitis B.

If the patient is infected with hepatitis B, he is initially in the acute phase of the hepatitis disease. In 2/3 of the cases this runs completely without symptoms and thus often goes unnoticed. However, 1/3 of the patients show symptoms such as jaundice or general flu-like symptoms such as abdominal discomfort, tiredness or loss of appetite. In the acute stage of hepatitis B, treatment is purely symptomatic, which means that patients with symptoms should above all ensure bed rest or physical rest and support the liver through a healthy diet and avoidance of alcoholic beverages. In most cases the symptoms subside after a maximum of 3-6 weeks. The hepatitis B disease heals in 95% of the cases without further consequences. In the rarest of cases, acute hepatitis is so severe that the patient must be treated with medication because the liver begins to fail. Antiviral therapy with interferons or antivirals is then used here.

Therapy of chronic hepatitis

As already mentioned, infection with hepatitis B can become chronic in about 5% of cases, which means that the immune system cannot fight the viruses sufficiently and they remain in the liver. Chronic hepatitis B has two drug approaches. Either interferons are used - typically the PEG-interferon-alpha - which support the immune system in fighting the virus. PEG-Inteferon-alpha is administered as a syringe once a week. If this therapy is not possible or if there is already advanced liver damage, antivirals in the form of nucleoside or nucleotide analogs are used. These drugs can be taken daily in the form of tablets and interfere with the reproduction of the hepatitis B viruses. If drug therapy fails, liver failure can occur and a liver transplant must be considered. You can find more information about these therapy options in the corresponding paragraphs of this article.

Interferons

Hepatitis B is a viral disease. That is why the so-called antiviral therapy is used. One group of substances in this therapy are the interferons, in which the interferon alpha is predominantly used. Interferons are the body's own signal molecules that are crucial for regulating our immune system. If a body cell is infected by a virus, the cell breaks down components of the virus and presents them on its surface via specific receptors. The so-called T cells of our immune system scan the cells from the outside and recognize the exogenous components of the virus and then activate the immune system - the infected cell is killed and the virus is fought.

Interferon alpha helps in this process as it stimulates the affected liver cells to produce more of these virus-presenting receptors. This makes it easier for the immune system to recognize infected cells. In addition, it causes our cells to produce more proteins, which then help break down the cells and limit the replication of the virus. Interferons are used in chronic hepatitis B with incipient damage to the liver in the form of so-called liver cirrhosis.

The common drug PEG-interferon-alpha has to be administered via a syringe once a week. The duration of therapy is usually between six to twelve months. Interferon-alpha must not be used in pregnant women or patients with advanced liver cirrhosis. A permanent remission (regression) of the disease can be achieved in approx. 30-40% of the patients. With interferon therapy, a definitive healing of chronic hepatitis B can only be expected in approx. 5-10% of patients.

Read more on this topic at: interferon

Nucleoside / nucleotide analogs

Another therapeutic option for chronic hepatitis B disease is the group of antivirals. A distinction is made between the so-called nucleoside analogs and the nucleotide analogs. The principle of action of the two substance groups is very similar: the drugs are similar to the building blocks that a virus needs to pass on its DNA, i.e. its genetic information. If the virus divides, it uses the drug as a component of its DNA - but this is chemically changed in such a way that the genetic information is broken off at this point and the virus cannot divide any further and thus multiply. This is also described by the name "antivirals", which means nothing other than that the virus is stopped from multiplying.

Typical substances in the nucleoside analogues are lamivudine, entecavir and telbivudine. Tenofovir is still mainly used as a nucleotide analog, its predecessor adefovir is no longer recommended. Antivirals are generally used when interferons are not effective or contraindicated, i.e. cannot be used, as e.g. you are pregnant or the liver damage is too advanced. Antivirals are often better tolerated than interferon-alpha and can be taken as tablets, which many patients find more pleasant.Since resistance occasionally occurs and the virus cannot replicate sufficiently, it often happens that a switch to another antiviral agent is necessary during the course of therapy. The duration of therapy depends on the response to the therapy and can only be ended when there are no longer any antigens for hepatitis B in the blood.

Various newer drugs are currently still being tested in studies. So far, a complete cure (curative therapy) has not been possible with these drugs. However, they alleviate the course of chronic hepatitis B and reduce the risk of long-term effects.

Liver transplant

If a patient falls ill with hepatitis B, this can lead to liver failure. This is a very dangerous complication as the liver is too damaged to continue functioning. Since the liver is a vital organ, patients with complete liver failure must receive a liver transplant. Liver cirrhosis or liver cell carcinoma caused by hepatitis B may also require a liver transplant.

This means that their liver is removed in an operating theater and that of an organ donor is used. However, since this liver is not recognized as the body's own by our immune system, it attacks the foreign organ - this is the term used to describe organ rejection. To counteract this, the patient then has to take medication for life that downregulates the immune system. These drugs are called immunosuppressants. So that the new liver is not also infected with the hepatitis B virus, an additional antiviral therapy with hepatitis B immunoglobulins and a virostat is carried out. Only when the blood values ​​are long-term negative for hepatitis B can the immunoglobulins be discontinued and preventive therapy with antiviral tablets alone can be carried out.

Read more on this topic at: Liver transplant

Homeopathy and home remedies

Hepatitis B is a serious disease, medical and drug treatment is essential! However, there are some home remedies or natural remedies that can help the patient affected. The most important thing here is to ensure a balanced and healthy diet so that the body has all the important vitamins and nutrients available. The liver should also be spared as much as possible and very fatty food and, above all, alcohol should be avoided. In the case of acute hepatitis B infection, the patient should above all take it easy - bed rest and avoidance of physical exertion is recommended. Many patients also report that warm liver compresses are perceived as beneficial.

Many herbal remedies can also have a supportive effect. Often reference is made to milk thistle, verbena, daisies, toadflax as tea or baths with seed oats. Alternative healing methods such as acupuncture are also available to patients. In addition, a supportive homeopathic treatment can be started. Phosphorus trijodatus C5 and Lycopodium clavatum C5 are particularly helpful here. Phosphorus 12C and 200C can also be taken as a support. An individual therapy can be determined by a homeopath.

Cost of therapy

The therapy of hepatitis B is borne by the social security and thus by the patient's health insurance. It should be noted that some services such as Medication prescriptions or hospital stays are provided with a cost share that the patient has to pay as an additional payment. How high these amounts are can be inquired at the respective health insurance company.

Prophylaxis of hepatitis B

The active vaccination against hepatitis B is usually given as a combination vaccination together with the hepatitis A vaccine. The body forms antibodies specific to this artificially reproduced component of the virus envelope, the HBs antigen. The vaccination is given three times in total (the second after 1 month and the last after six months after the first vaccination). The immunization must be refreshed after approx. 10 years.

Read more on the subject at: Vaccination against hepatitis B

Vaccination for children and adolescents is recommended by the STIKO (Standing Vaccination Commission) and included in the vaccination calendar. Especially people in:

• Healing and nursing professions,
• Dialysis patients,
• Promiscuous,
• i.v. Drug addicts and
• Travelers to risk areas should take advantage of the vaccination.

If the child is infected during birth, a combination of hepatitis B hyperimmunoglobulin (passive vaccination) and hepatitis B vaccine can be given to the child within 12 hours.

The vaccination is injected into the muscle (intramuscular, IM) and is well tolerated. Serious intolerances are rarely observed.

In the event of HBV exposure (e.g .: stab injury from an injection needle, potential contact with hepatitis B), passive vaccination is possible, in which immunoglobulins (antibodies) are administered. This vaccination is done less often because it is less safe. The effect of passive immunization only lasts for a few weeks.

Read more on this topic: Transmission of hepatitis B