There is no treatment for “acute” hepatitis B as most adults will naturally clear the virus. Treatment is available for “chronic” hepatitis B which is indicated where there is active viral replication, persistent elevated ALT levels and evidence of ongoing liver damage.
The aim of treatment is to stop or reduce viral replication, stop or reduce liver damage (thus improving liver function) and improve quality of life. It is rare for treatment to eradicate the virus.
There are a number of treatments for hepatitis B. These are as follows:
- Lamivudine (Zeffix®)
- Adefovir (Hepsera®)
- Entecavir (Baraclude®)
- Pegylated Interferon (Pegasys®)
Lamivudine, Adefovir and Entecavir are usually in the form of tablets or capsules taken orally. It is important that these medications be taken exactly as described. Long term use may lead to the development of mutations of the hepatitis B virus and drug resistance. Pegylated Interferon is a self-administered injectable medication (similar to a diabetic insulin injection) which must be kept refrigerated until use.
Anyone preparing to begin treatment for hepatitis B should discuss with their doctor the duration of treatment, as it may vary depending upon the medication prescribed, and a person’s drug responsiveness.
Side Effects
As with any medication, pegylated interferon may have unwanted side effects. All of the possible side effects are not experienced by everyone undertaking treatment and the degree to which they are experienced is variable. It has also been noted that the severity of some side effects of pegylated interferon are reduced when compared to unpegylated interferon. Some of the more common side effects include.
- Insomnia
- Fatigue
- Headaches
- Myalgia (muscle pain)
- Flu-like symptoms
- Irritability
- Anger/aggression
- Mood swings
- Impatience/intolerance
- Depression
- Cognitive impairment
- Loss of concentration
- Poor memory
- Changes in thinking
- Skin rashes and dry skin
It has been found that many people who plan strategies around the possible side effects of treatment manage the experience better than those who don’t. The majority of people either don’t suffer severely from side effects or are able to manage them well. Approximately 20% of people will experience more severe side effects or find them more difficult to manage. There is no way of predicting who will experience side effects, or to what extent. It is important that people planning to undertake pegylated interferon treatment for hepatitis B take the possibility of side effects seriously. People should plan strategies for managing side effects and explore their practical and emotional support options prior to beginning the treatment. Anecdotal evidence suggests that most people with hepatitis B undergoing pegylated interferon therapy experience less side effects than do people with hepatitis C.
Support in planning treatment strategies is available both from the Support Officer at HepatitisWA and from the nursing staff at the liver clinics.
Lamivudine is a one a day tablet taken for a year or more. Side effects may include:
- Diarrhoea
- Headache
- Fatigue
- Chills
- Loss of appetitie
- Trouble sleeping
- Depression
- Cough
- Runny nose
Like Lamivudine, Adefovir is a tablet taken once a day for a year or more. Currently, Adefovir is only prescribed for people who have developed resistance to Lamivudine. Side effects for Adefovir include:
- Weakness
- Headache
- Diarrhoea
- Cough
- Sore throat
- Runny nose
- Indigestion
Entecavir is a daily tablet taken for up to a year. Entecavir is now commonly the first medication prescribed for hepatitis B. The side effects for Entecavir could include:
- Headache
- Dizziness
- Diarrhoea
- Heartburn
- Drowsiness
- Difficulty getting to sleep
- Disturbed sleep
Side effects can be serious and it is important that medical staff be kept informed, especially if they are severe or prolonged. Any rash or numbness, tingling or burning in the fingers or toes should be reported immediately as these may indicate an allergic reaction.
Managing Side Effects
Some side effects may require medical intervention, (eg depression may require antidepressants), while other side effects can be effectively self-managed. There are some simple guidelines for managing most side effects, some of which are listed below.
Attitude
It is important to maintain a positive, but realistic attitude while undertaking treatment. Studies have shown that a positive attitude is beneficial in a number of illnesses and treatment situations. A recent report into the experiences of hepatitis C treatment defines positive attitude as one of the factors that helped people cope with the side effects they experienced. This is equally true for any medical condition requiring a prolonged treatment regime with the possibility of unwanted side effects. It may, however, be difficult at times to remain positive. Some steps that may help in maintaining a positive attitude are listed below:
- Make a list of the reasons for undertaking treatment
- Read them often
- Each morning think of things to be grateful for
- Restructure negative thoughts into positive thoughts
- Each night, define what worked (and what didn’t) during the day
- Congratulate yourself at the end of each day–you are a step closer to achieving your goal of treatment completion
(Max Hopwood, Carla Treloar, Louise Redsull – Monograph 4/2006 – Experiences of hepatitis C treatment and its management: What some patients and health professionals say – NCHSR)
Support
It is important to have an effective support system in place prior to going on treatment. Secure support from as many people as possible including family, friends, work colleagues and health care providers. Find out about support available from HepatitisWA and liver clinics.
Exercise
One of the most important factors in maintaining good health, exercise is beneficial in reducing treatment-related fatigue and is important in helping you feel better physically and mentally. Moderation is the key and physical activity needs to be at a level that is realistic and achievable. Some low-impact activities include:
- Walking
- Swimming
- Gardening
- Pilates
- T’ai chi
- Stretching
- Dancing
- Yoga
- Yogalates
Relaxation
Undertaking treatment can be stressful. Some people will be overwhelmed by the experience of treatment, managing side effects and maintaining their normal life. Building in time for relaxation can help to reduce stress.
- Meditation. Some people find it helpful to have a mantra to help them maintain focus while meditating.
- Aromatherapy used in conjunction with gentle music or a guided meditation.
- Controlled breathing exercises.
- Sit or walk somewhere quiet and relaxing and just take some time out.
Eat Well
A nutritious balanced diet is vital to maintain energy levels, general good health and feelings of well-being. For further information on healthy eating, contact HepatitisWA or click here to see our fact sheet on “Diet and Hepatitis C”.
Support is available from the Support Officer at HepatitisWA and from the nursing staff at the liver clinics.
