If you have used antiviral medicine once without success or have had a relapse after treatment, your choices are different, and this information does not apply to you. Talk with your doctor to decide what is right for you.
You have chronic hepatitis B when the virus is active in your body for more than 6 months. The virus can damage liver cells and cause your liver to become swollen and tender.
Most people who have chronic hepatitis B don't have symptoms. But they can still pass the infection to other people, especially the people they live with or have sex with, unless they receive treatment that gets rid of the virus.
Most people with chronic hepatitis B don't develop serious problems. But about 15 to 25 people out of 100 who have the infection will die of cirrhosis or liver cancer.1 When there is a lot of the virus in your body, your chance of having these problems is greater. Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.
There are several antiviral medicines that can be used to treat chronic hepatitis B. They are sorted into two groups:
When you take interferons, you are less likely to relapse after you stop taking the medicine than if you took NRTIs. But fewer people are helped by interferons than by NRTIs.2
Experts recommend antiviral medicines if you have high levels of both the hepatitis B virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
But antiviral medicines may not be right for everyone. The medicines can be helpful if you have or are likely to get liver damage, such as cirrhosis. But they may not help if you already have severe liver damage. People who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some of these medicines.
You may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and if your liver isn't damaged. Your doctor may remove a tiny piece (biopsy) of your liver to see if it has been affected by the virus.
Results from your blood tests can help you and your doctor decide which treatment might work best for you or if you need to take any medicine at all. Some people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups to watch for liver problems. Others may not need medicine right away, but will start taking antivirals later if tests show that the virus is active.
Antiviral medicines can stop or slow the growth of the hepatitis B virus and help prevent serious liver problems.
Interferon stops the growth of the hepatitis B virus over the long term in about 35 out of 100 people.2 This means that it doesn't stop the virus in about 65 out of 100 people. Recent studies suggest that peginterferon works a little better than interferon.3, 4
NRTIs slow the growth of the hepatitis B virus in your body. Studies show that lamivudine and adefovir can reduce liver damage in about half of the people who take these medicines.5, 6 Entecavir can greatly reduce liver swelling and scarring. Tenofovir is effective at reducing the amount of hepatitis B virus in the body.7 Some studies show that entecavir works better than lamivudine or adefovir.8, 9, 10 Tenofovir works better than adefovir against hepatitis B virus that is resistant to lamivudine.11
Antiviral medicines can have serious side effects that may cause problems throughout your treatment. Some people are not bothered by the side effects, while others stop taking their medicines because they feel too sick to finish them.
If you take interferons, you're more likely to have side effects than if you take NRTIs.
Side effects of interferons include:
In rare cases, interferons can cause confusion and might affect your heart, thyroid, or kidneys.
Side effects of NRTIs may include:
In rare cases, NRTIs have caused severe liver problems or a buildup of acid in the blood.
After any kind of treatment for hepatitis B, there is a chance that the virus will come back after you've stopped treatment.
The virus may also become resistant to the drug that you're taking. This means that the medicine no longer works to stop or slow the virus. If this happens, you may have to try another medicine. Drug resistance is more likely with some NRTIs.
Your doctor might recommend antiviral medicines if:
|Take antiviral medicine||Don't take antiviral medicine|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"My doctor says I have a good chance of doing well on interferon. My HBV DNA test showed that I have a pretty low level of the virus in my body. And my blood tests showed that my liver enzymes are high. Those factors mean I might do well on the medicine. And I guess women have better success than men, so that's another thing in my favor. I'm not wild about giving myself shots, but I'd rather do that than have major liver damage."
— Barbara, age 45
"I found out a couple of years ago that I have hepatitis B. I thought about taking any medicine I could to help my liver. But so far, my tests show that my liver is in good shape. My liver enzyme levels are normal, even though I still have the virus in my body. It might not do me any good to take medicines yet. I'll have my liver checked regularly, and if things change, I'll reconsider."
— Phil, age 28
"I've got diabetes as well as infection with hepatitis B virus. That means my immune system may not be as strong as it could be, so interferon may not help me much. But some people do really well on entecavir. I also like the fact that I can take it as a pill and do not have to have shots."
— Jamal, age 34
"I just found out I'm infected with the hepatitis B virus. My symptoms weren't bad, just a little nausea. My liver enzymes are up a little, but so far there is no evidence I have any serious damage to my liver. It can take a while to develop that, and since I'm older, it could be years away. I think I'll just keep an eye on it and visit my doctor for checkups."
— Teresa, age 55
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antiviral medicine for hepatitis B
Reasons not to take antiviral medicine for hepatitis B
I'm willing to take pills or get shots to help get rid of the virus in my body.
I don't like taking pills or getting shots.
I'm worried that I might spread the virus to others if I don't treat the infection.
I'm not worried about spreading the virus to others.
I'll do whatever I can to avoid getting liver disease or liver cancer.
I'm not worried about getting liver disease or liver cancer.
I'm willing to deal with the side effects of treatment.
I'm worried that I might not be able to deal with the side effects of treatment.
I'm not worried about missing work to go to the doctor for the exams and tests that I need.
I can't afford to take time off from work to go to the doctor.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking antiviral medicine
NOT taking antiviral medicine
1. If I have a lot of the hepatitis B virus in my blood and my liver enzymes are high, I may need to take medicines to treat the infection and prevent liver disease.
2. There are medicines I can take to treat my infection, but I may have trouble taking some of them because of the side effects.
3. It's important that I get regular checkups to be sure the infection isn't getting worse and that the medicine is working.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||W. Thomas London, MD - Hepatology|
Lok SFL, McMahon BJ (2009). Chronic Hepatitis B: Update 2009. Available online: http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf.
Leung N, et al. (2009). Early hepatitis B virus DNA reduction in hepatitis B e antigen-positive patients with chronic hepatitis B: A randomized international study of entecavir versus adefovir. Hepatology, 49(1): 72–79.