Treatment

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Hepatitis A

Hepatitis A, or HAV, differs from HBV and HCV in that it doesn't cause chronic infection or chronic liver disease. Almost all cases resolve after a few weeks. About 15 percent of infections produce relapsing symptoms over six to nine months and about one in 100 to 1000 HAV cases produce a sudden, severe liver infection that may require a transplant. However, because its symptoms can be sudden and severe, hospitalization may be necessary for patients who become dehydrated from vomiting or who have severe hepatitis.

Hepatitis B

Acute hepatitis B usually resolves spontaneously (in 95 percent of cases) and no specific therapy is advised. However, approximately 5 percent of infected patients may not clear HBV, and go on to develop chronic infection with progressive disease and a risk of liver cancer.

Three drugs have been approved for chronic HBV treatment, alpha-interferon, lamivudine, and adefovir. Alpha interferon is taken by injection in a dose of 30 MU/week for 4 to 6 months and sustained virologic response (prolonged clearance of HBV DNA) is achieved in approximately 20 to 30 percent of patients. Recent results with peginterferon alfa-2a (Pegasys), 180 ug/wk for 48 weeks, suggest improved effectiveness, but this drug is not yet approved for treatment of hepatitis B.

Lamivudine (Epivir HB, also called 3TC) was approved a few years ago for treatment and is available in pill or liquid form. A drug first developed for treating AIDS, lamivudine works by stopping the virus from reproducing. Studies indicate that lamivudine is effective in suppressing the virus in nearly all patients and is well tolerated in the low doses used for HBV, 100 mg/d. However, most patients relapse once the drug is discontinued and HBV frequently develops resistance to lamivudine with long-term use., with about half of patients treated for three years becoming resistant to lamivudine. Patients who undergo seroconversion from HBeAg to HBeAb during lamivudine therapy may experience long-term remission, even after withdrawal of drug.

Adefovir (Hepsera) is the most recent oral antiviral agent approved for chronic HBV. This drug is also blocks viral replication and is effective against not only natural strains of hepatitis B but also those strains that develop resistance to lamivudine. Resistance mutations to adefovir, although rare, have now been described. To date, all the strains of HBV that have been resistant to adefovir are sensitive to lamivudine, prompting some investigators to suggest combination therapy.

No diet has been shown to help treat the virus. As a preventive measure, you should avoid alcohol if you are infected, as well as other liver toxins, such as acetaminophen (limit use of acetaminophen to 2g or less per day). Patients with chronic hepatitis B should be checked for pre-existing immunity to hepatitis A by testing for anti-HAV IgG. Those who test negative should undergo hepatitis A vaccination. It is especially dangerous to combine analgesics (such as aspirin, ibuprofen and acetaminophen) with each other or with alcohol if you are infected with HBV.

Hepatitis C

Fifty to 85 percent of adults infected with hepatitis C, or HCV, develop a chronic or life-long infection. Infection is considered chronic if HCV-RNA remains positive for more than six months. High enzyme levels may indicate that the liver is being damaged but a biopsy is needed to determine the extent of damage. Approximately 40 percent of infected HCV patients have normal liver enzymes.

Doctors measure the level of HCV virus in blood and genotype of HCV to plan treatment. A genotype is a specific strain of the virus. There are many different genotypes (specific strains of the virus) of HCV, the most common of which is genotype 1. More than 70 percent of US patients with hepatitis C are genotype 1.

Clinical trials have shown that combination therapy-taking ribavirin and interferon together-is much more effective than interferon alone, and is now considered standard therapy for chronic hepatitis C. Approximately 40 to 45 percent of genotype 1 patients with high viral load (greater than 850,000 IU/ml) and 50 to 60 percent of genotype 1 patients with low viral load achieve a sustained virologic response with 48 weeks of treatment. In contrast, those with genotypes 2 and 3 tend to respond better to treatment (up to 82 percent) with 24 weeks of treatment. Recent unpublished data, presented at the American Association for the Study of Liver Diseases annual meeting in 2004 suggests that patients with genotype 2 infection may only need 14 to 16 weeks of therapy, while patients with genotype 3 infection and high viral load may require 48 weeks.

Common side effects from treatment include flu-like symptoms, such as muscle aches, fever, chills and headaches. Often, these can be managed by taking interferon at night or by lowering the dosage. Acetaminophen or similar agents can also reduce flu-like symptoms if taken before treatment. Other side effects include depression, hair loss, rash and thyroid disorders.

In addition to antiviral therapy, it is recommended that HCV patients not drink alcohol in excess. They should also get vaccinated against other types of hepatitis, and see a doctor regularly.