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Is chronic hepatitis B curable?

Friday, 13 November 2009
Answered by: Dr Anil Handoo
Consultant, Department of Haematology, B L Kapoor Memorial Hospital, New Delhi
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Q. Can chronic hepatitis B virus be treated? If yes, how long will it take to eliminate the virus from the blood? Can the patient get antibody after the treatment? If yes, how long will it take? What food should be he avoided during treatment? Is travelling advisable?

A.  The main goal of treatment of chronic hepatitis B is to suppress HBV replication and to induce remission of liver disease before development of cirrhosis and hepatocellular carcinoma. There is "NO CURE" as of now. Therapy is done using interferon-a, oral lamivudine and oral adefovir. On therapy, the virus will still remain in the body, however, as mentioned earlier, active replication of the virus would hopefully cease. To assess the response to treatment one has to have undetectable HBV DNA (< 105 copies/mL) in serum, sustained loss of HBeAg with or without detection of anti-HBe (HBeAg seroconversion), and improvement in liver disease, normalization of aminotransferases and decrease in necroinflammation or fibrosis progression halted. Depending upon the drug used the response time varies between 4 months to a year’s time. There, however, still will some cases which do not show a favourable response and in some there would be drug resistance. If no seroconversion (i.e.: loss of HBeAg) is seen after 1 year of oral medication the decision whether to continue treatment will be influenced by the costs (higher for adefovir) and the risk that drug resistance (higher for lamivudine) will develop. Again, seroconversion itself does not mean, “cure”, assessment of HBV DNA is also required. If Viral load becomes significantly low or undetectable, patients should be referred directly for liver transplantation.

I would suggest to get in touch with a good gastroenterologist and hepatologist to guide you appropriately.

As far as avoidance of food is concerned, the liver that normally functions as the body’s filtering system is not working up to par. The hepatitis diseased liver is unable to break down potentially toxic molecules and byproducts from substances you ingest. With a faulty filtering system, dangerous levels of everything from alcohol to protein, fats and certain vitamins and minerals may accumulate in the body, with potentially serious adverse consequences to the liver. This doesn’t mean you must eat a bland diet or obsess about every morsel of food. But by avoiding or moderating your intake of foods that may potentially harm the liver while choosing foods that help it. Avoid alcohol intake and high protein diets. It has been seen in various studies that there is long term help in liver function by dietary restriction of total calories, fat, iron, and protein. While travelling is not contraindicated in Hep B infection, working in other countries will depend upon the company policies and regulatory issues in the respective countries.

A.  The main goal of treatment of chronic hepatitis B is to suppress HBV replication and to induce remission of liver disease before development of cirrhosis and hepatocellular carcinoma. There is "NO CURE" as of now. Therapy is done using interferon-a, oral lamivudine and oral adefovir. On therapy, the virus will still remain in the body, however, as mentioned earlier, active replication of the virus would hopefully cease. To assess the response to treatment one has to have undetectable HBV DNA (< 105 copies/mL) in serum, sustained loss of HBeAg with or without detection of anti-HBe (HBeAg seroconversion), and improvement in liver disease, normalization of aminotransferases and decrease in necroinflammation or fibrosis progression halted. Depending upon the drug used the response time varies between 4 months to a year’s time. There, however, still will some cases which do not show a favourable response and in some there would be drug resistance. If no seroconversion (i.e.: loss of HBeAg) is seen after 1 year of oral medication the decision whether to continue treatment will be influenced by the costs (higher for adefovir) and the risk that drug resistance (higher for lamivudine) will develop. Again, seroconversion itself does not mean, “cure”, assessment of HBV DNA is also required. If Viral load becomes significantly low or undetectable, patients should be referred directly for liver transplantation.

I would suggest to get in touch with a good gastroenterologist and hepatologist to guide you appropriately.

As far as avoidance of food is concerned, the liver that normally functions as the body’s filtering system is not working up to par. The hepatitis diseased liver is unable to break down potentially toxic molecules and byproducts from substances you ingest. With a faulty filtering system, dangerous levels of everything from alcohol to protein, fats and certain vitamins and minerals may accumulate in the body, with potentially serious adverse consequences to the liver. This doesn’t mean you must eat a bland diet or obsess about every morsel of food. But by avoiding or moderating your intake of foods that may potentially harm the liver while choosing foods that help it. Avoid alcohol intake and high protein diets. It has been seen in various studies that there is long term help in liver function by dietary restriction of total calories, fat, iron, and protein. While travelling is not contraindicated in Hep B infection, working in other countries will depend upon the company policies and regulatory issues in the respective countries.

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