Chronic Hepatitis B

Chronic Hepatitis B – General Information

The Chronic Hepatitis B virus affects the patient’s liver, thus causing a swelling called hepatitis. This virus is a DNA virus and a single of many non-related viruses which can cause viral hepatitis. This disease was initially known by the name of "serum hepatitis”, and has resulted in epidemics in some parts of Africa and Asia. Chronic Hepatitis B is now endemic in China and some other Asian continent parts. The world's population which is currently plagued with the virus is estimated at 3 percent to 6 percent, but almost a third of the world’s population is thought to have been exposed to the virus.

The earliest record from an epidemic that was caused by the Chronic Hepatitis B virus was created by Lurman in the year 1885. An epidemic of smallpox occurred in Bremen in the year 1883 and one thousand two hundred eighty-nine employees of a shipyard were to be vaccinated with other people’s lymph. After several weeks had passed, and eventually after up to eight months, 191 vaccinated workers were ill, presenting jaundice. They have been diagnosed to suffer from serum hepatitis. Some other workers who were inoculated with some different lymph batches stood healthy. Lurman's paper (which is now looked at like a classical epidemiological study example) revealed that lymph which was contaminated was the true outbreak source. Later, a lot of similar outbreaks have been reported to follow the introduction. In 1909, a group of hypodermic needles were used, and then, more importantly, even reused in the administration of Salvarsan to treat of syphilis.

Chronic Hepatitis B – Symptoms

Infection of the Hepatitis B virus can be either acute (the one which is self-limiting) or chronic (the one which is long-standing and leads to Chronic Hepatitis B). People with a self-limiting infection can usually make the infection disappear spontaneously in several weeks (a few months maximum).

Unfortunately, children have fewer chances that the regular adult to effectively clear the infection. However, more than 95 percent of people that become infected when they are adults or old children can show full recovery and develop virus protective immunity. On the other hand, only 5 percent of newborns who acquire this infection from their mothers when birth takes place will survive the infection. Those infected between one to six years have a clearance rate of 70%.

The infection with the Chronic Hepatitis B virus can be either asymptomatic or it can be associated with chronic liver inflammations (chronic hepatitis), which may lead to cirrhosis after several years. This infection type can dramatically increase the incidence of a widely spread medical disorder: liver cancer.

Half of all the patients which are infected with the virus have no symptoms. This disorder’s symptoms include:

• Loss of appetite
• Feeling exhausted (fatigue)
• Nausea and vomiting
• All-over itching of the body
• Liver pain (on the right side of the abdomen, under the lower rib cage)
• Jaundice - A condition where the skin and the eye whites turn yellow
• Urine is dark in colour (like cola/tea).
• Stools colour-pale (greyish or clay coloured).

Chronic Hepatitis B – Treatment

Alpha-interferons are known to be the first drugs in the US that have been approved for treating Chronic Hepatitis B. An Interferon treatment is usually recommended in the case of patients who have the "replicative disease" (a.k.a. HBeAg positive). About 40 percent of such patients will lose the HBeAg serum after 16 weeks of intense treatment with the Interferon-alpha drug. The loss of HBeAg can be correlated with a prognosis which is improved. A few patients who are treated (less than 10%) can even be cured by this. Patients who are treated with the Interferon-alpha drug should present clear evidence of an infection with the virus that causes this disorder. Furthermore, the presence of Chronic Hepatitis B surface antigen in the patient’s blood ought to be documented for about six months. The individuals should also detain virus replication evidence, which can be documented the presence in the patient’s blood of the hepatitis B e antigen. Ongoing liver inflammation may also be present. A biopsy of the liver must also be done before treatment. Patients who have severe and decompensated disease of the liver (for example encephalopathy, very high serum bilirubin, ascites, prolonged prothrombin time) must not be allowed to follow a treatment that implies the intake of the Alfa Interferon.

The recommended interferon Alfa-2b dose for this disorder’s treatment is five million units daily. The dose must be administered by intramuscular of subcutaneous injection, for 16 weeks. The individual must be carefully monitored during his or her treatment for side effects like flu-like symptoms, rashes, depression, other reactions and blood counts which are abnormal. A meta-analysis of a few randomized interferon alfa-2b trials in patients with Chronic Hepatitis B treatment revealed this treatment to be cost-effective. This study showed that interferon alfa-2b treatment is able to decrease viral replication, revealed by loss of serum hepatitis B e antigen, in more than 45 percent of patients, which is compared to a little less than 10 percent of the untreated patients. About 8 percent of patients have also lost the hepatitis B virus surface antigen in one year of intense treatment, which is compared to a 1% yearly average rate for untreated individuals. Other options in the case of the treatment for this disorder may include nucleoside analogues. In 1998, December, the US Food and Drug Administration approved the drug lamivudine, also named 3TC and also effective against HIV, for the treatment of Chronic Hepatitis B (individuals who have become HBeAg positive). Lamivudine can be taken orally in a quantity of 100 mg/day for this medical condition. In some studies where the drugs were compared, lamivudine was equally useful to Interferon-alpha in creating a lessening of HBeAg serum. It has also been shown to create better liver biopsy results in individuals treated for one year. In 2002, the US Food and Drug Administration approved adevofir dipivoxil, another analogue of the nucleoside, for treating the Chronic Hepatitis B. The average dose is 10 mg/day.