Hepatitis B Treatment and Side Effects

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.

In Australia treatment for chronic (long term) hepatitis B is available free of charge at major hospitals through liver clinics. In order to qualify for treatment, a person must have had hepatitis B for at least six months (classed as chronic hepatitis B), and blood tests must show that the virus is active and liver damage is occurring. Some people may need a liver biopsy (?) which is a clinical procedure where a very small piece of liver is removed with a needle to determine how much liver scarring and inflammation has occurred, however as a rule a biopsy is not required. Please contact HepatitisWA for further information.

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®)
• Tenofovir (Viread®)
• Pegylated Interferon (Pegasys®)

Lamivudine, Adefovir, Entecavir and Tenofovir are usually in the form of tablets or capsules taken orally.  It is important that these medications be taken exactly as prescribed.  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 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.   Some of the more common side effects include.

• Insomnia
• Fatigue
• Headaches
• Myalgia (muscle pain)
• Flu-like symptoms
• Irritability
• Depression
• Loss of concentration

It has been found that those who plan strategies around possible side effects manage the treatment experience better than those who don’t.  Most people either don’t suffer severely from side effects or are able to manage them well. There is no way of predicting who will experience side effects, or to what extent. It is important when planning to undertake pegylated interferon treatment for hepatitis B to take the possibility of side effects seriously but optimistically. 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 once a day tablet.  Side effects may include:

• Diarrhoea
• Headache
• Fatigue
• Chills
• Loss of appetitie
• Trouble sleeping
• Depression
• Cough
• Runny nose

Adefovir is a tablet taken once a day.  Currently, Adefovir is prescribed for people who have developed resistance to Lamivudine.  Adefovir should not be taken in conjunction with Tenofovir.  Side effects for Adefovir include:

• Weakness
• Headache
• Diarrhoea
• Cough
• Sore throat
• Runny nose
• Indigestion

Entecavir is a once daily tablet.  Entecavir is often 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

Tenofovir is the most recently approved medication for chronic hepatitis B and is a once daily tablet.  It is not to be taken in combination with Adefovir and a dose adjustment may be required if a patient has renal impairment.

• Nausea
• Abdominal pain
• Diarrhea
• Headache
• Dizziness
• Fatigue
• Nasopharyngitis
• Back pain
• Skin rash

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. 

Anyone experiencing nausea, vomiting, abdominal pain, lethargy, abnormal breathing, low blood pressure and irregular heart rhythm should seek immediate medical advice.

Hepatitis B treatment should not be stopped abruptly unless on medical advice as severe exacerbation of acute hepatitis B symptoms may occur.  Liver function should be monitored closely for at least several months in those who have ceased treatment. 

Managing Side Effects

Some side effects may require medical intervention, (eg depression), 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 B 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.

(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

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, check out our fact sheet on Diet and Hepatitis.

Support is available from the Support Officer at HepatitisWA and from the nursing staff at the liver clinics.

Page last updated: Friday 15 July, 2011