Chronic Hepatitis B Management

Management of Chronic Hepatitis B, From a public perspective, prevention of Hepatitis B virus infection through vaccination is the optimal way to reduce the disease burden by hepatitis B. but there are many millions of individuals already infected with Hepatitis B virus (HBV). For these individuals, therapeutic agents are needed to reverse existing liver disease and prevent future disease progression.There are two types of chronic hepatitis; Chronic persistent hepatitis and Chronic Active Hepatitis.

Immunization with hepatitis B vaccine, Hepatitis B virus infection can be prevented through immunization with hepatitis B vaccine. Hepatitis B vaccination prevents HBV infection in approximately 95 percent of recipients who complete the course of 3 vaccinations. This vaccine can also prevent infection in individuals with known exposure to hepatitis B virus, including vertical hepatitis B virus transmission (neonates born to HBsAg positive mothers). For these cases, Hepatitis B immunoglobulin and Hepatitis B vaccine are often administered together immediately after exposure.

Chronic Hepatitis B Therapy, recently therapeutic options for hepatitis B include a spesific antiviral agent in addition to interferons and related immunomodulators, traditional medicines and various palliative therapies. Antiviral agent act directly against the virus to inhibit replication and reduce viral load, leading to improvements of HBV associated liver disease. Reduced level of Hepatitis B virus are associated with fewer antigens to provoke an attack by immune system. 

The most widely used for treating chronic hepatitis B is interferons alpha (IFN-α). Interferons are proteins released by the immune system in response to infections. In treating chronic Hepatitis B, Interferons are thought to stimulate Hepatitis B virus Infected cells to produce host proteins that help clear the infection. Immunomodulators act through several mechanisms to reduce the ability of liver cells to support virus replication and stimulate the existing Hepatitis B virus specific immune response. Immunomodulators such as IFN-α are effective only in a minority or patients.

Associated factors relatively to outcome IFN-α therapy:

• Adult-acquired disease
• High baseline Alanine transaminase (ALT) levels
• Low baseline Hepatitis B virus DNA
• Gender
• Absense of cirrhosis
• Non-Asian ethnicity

Alanine transaminase (ALT) is an enzyme released from damage hepatocytes and elevated levels in the blood suggest the presence of necro inflammatory liver disease. Serum ALT concentrations, especially if measured regularly as disease progresses, correlate reasonably well with liver necrosis assessed histologically. Although ALT does not provide a good indication of the stage of liver disease, and concentrations of ALT may even decline in advanced disease.

Evaluation of Liver Disease in Hepatitis B Patients : Liver Disease Indicator in hepatitis B patients

• Alanine Transaminase (ALT), Increase suggests hepatocyte damage
• Aspartate Transaminase (AST), Increase suggests hepatocyte damage
• Alkaline phosphatase, Increase suggests hepatic dysfunction
• Liver Histology, Indicator of disease stage (fibrosis) and grade of disease (necro inflammatory activity)
• Ultrasound, Identifies tumours or extensive scarring
• Albumin, Reduced levels suggests hepatic insufficiency
• Bilirubin, Increase suggests hepatic excretory dysfunction
• Prothrombin time, Increase suggests hepatic dysfunction

Liver Histology, Histologic analysis of liver biopsy samples provides a direct and complete assessment of liver disease. Liver Histology is a more sensitive and accurate indicator of liver disease than serum ALT, which can change in response to unrelated factors.

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