Antiviral treatment

Effective treatment for hepatitis B is available!

Hepatitis B is a DNA virus and once the virus gets inside the body, it travels to the liver and infects a person’s liver cells (called hepatocytes). The virus hijacks the liver cells own proteins to reproduce and may numerous new viruses, which are then released to begin the cycle again. In addition to making new viruses, HBV uses the liver cell to make a protein called hepatitis B surface antigen (HBsAg). Screening for HBV usually involves checking a person’s blood for the HBsAg. If HBsAg is present in the blood, it indicates there is an active HBV infection in the liver that needs further care. Unfortunately, in some settings in Africa, diagnostic tests may not be available or may suffer from low accuracy.

One of HEPSANET’s research priorities is to develop and evaluate new diagnostic tests for HBV in Africa.

Several antiviral treatments are available for HBV. In Africa the most common one is a medicine called tenofovir. Tenofovir is a pill that is taken once per day and it blocks an enzyme calls reverse transcriptase. This prevents HBV from making new viruses. Coincidentally tenofovir is also very common antiviral used to treat HIV as blocking the reverse transcriptase is also a way to control HIV infection. Tenofovir comes in two forms that may be available at your clinic: tenofovir disoproxil fumarate and tenofovir alafenamide

Who needs HBV antiviral treatment?

After diagnosis, a person living with HBV should be evaluated by health worker. Part of the evaluation is to determine when to start antiviral treatment. This evaluation involves a physical examination, blood tests, and possibly a painless scan of the liver/abdomen. For some people with HBV, such as those with serious liver damage, a strong family history of liver cancer, or coinfection with HIV, treatment is recommended immediately. For others, who have mild or “inactive” infections, where there is little or no liver damage, treatment is often deferred by the health worker. Often in mild infections the body’s own immune system manages to keep the virus in check, and hence taking medication is un-necessary. Although antiviral treatment may not be needed right away, people with HBV should continue to be reviewed regularly and at least every year by the health worker to see if the situation changes. It is possible that some people may not require the treatment. Unfortunately, decisions to start or defer antiviral treatment in Africa are based on data from people in other parts of the world where the HBV virus, host genetics, and environmental factors are diverse.

HEPSANET aims to define the best criteria for when to start antiviral treatment in Africa and evaluate the benefits and harms of earlier treatment.

Benefits of antiviral treatment

If you have been prescribed antiviral treatment, there are many proven benefits:

·         Improves quality of life

·         Reduces the risk of developing liver cancer (hepatocellular carcinoma).

·         Reduces the risk of transmission of HBV to other people

·         Reverses liver damage and begins recovery of the liver, even in patients with advanced liver disease (cirrhosis).

One of HEPSANET’s research priorities is to measure the long-term benefits of treatment of HBV in Africa.

What are the side effects of antiviral treatment?

All medications have potential side effects. The most common side effects to tenofovir are mild including stomach or bowel upset and/or headache, but these are usually mild and go away with time. Rarely, more severe side effects are possible, including kidney and bone problems. Therefore, many health workers will check your urine and/or blood for kidney function before and while you are taking tenofovir and stop the medication if a problem is found. If you have major problems with your bone health, your health worker may monitor something called bone mineral density.

How long do I need to take antiviral treatment? When can I stop?

While the treatment blocks the HBV from making new viruses in the liver, the virus often remains active in producing the HBsAg. We know that if the HBsAg remains positive and treatment is stopped, the virus will revert back to causing problems. During treatment, the health worker will likely re-check the HBsAg periodically. Once the HBsAg becomes negative (i.e., no HBsAg in the blood), treatment can stop. Unfortunately, this happens rarely, and most patients need to take treatment for decades and possible for the rest of their life. Also, if the person with HBV also has HIV, the treatment is continued as it is also keeping HIV in check.

This is a major focus of HBV research: to find a short duration treatment or cure for HBV or a cure that reduces the need for long-term antiviral treatment.

One of HEPSANET’s research priorities is to evaluate criteria for stopping antiviral treatment in people in Africa who remain HBsAg-positive.

Beyond antiviral treatment is there anything a person with HBV can do to stay healthy?

Regardless of whether your health worker has prescribed antiviral treatment, people with HBV should try to adhere to the following lifestyles:

• Reduce or minimize alcohol use

• Maintain a healthy body weight and avoid obesity

• Exercise on a regular basis

• Get screened for diabetes and maintain control of glucose if diabetic

• Tell your health worker you have HBV to avoid being prescribed any medications that can harm the liver

• If taking herbal/traditional medicine, discuss with your clinician and avoid ones that can harm the liver

One of HEPSANET’s research priorities is to evaluate the impact of co-factors and co-morbidities on HBV outcomes in Africa.