Hepatitis B - Treatment 

Treating hepatitis B 

Hepatitis B and pregnancy

It is unclear whether many of these medications discussed on this page are safe to take during pregnancy.

Ideally, if you are trying to have a baby, discuss your plans with your doctor first, as it may be necessary to switch medication or stop it altogether.

If you think you may have become pregnant, tell your doctor as soon as possible.

If you are diagnosed with hepatitis B, it is likely that your GP will refer to you a specialist, usually a hepatologist (a liver specialist).

Most people tend to be free of symptoms and recover completely within a couple of months, never going on to develop chronic (long-term) hepatitis.

There is usually no specific treatment for acute (short-term) hepatitis B. Unless your symptoms are particularly severe, you should be able to manage them at home.

You can take over-the-counter painkillers such as ibuprofen and paracetamol and may be prescribed codeine if pain is more severe. Nausea (feeling sick) can often be controlled with a medication called metoclopramide.

If you are diagnosed as having a hepatitis B infection, you will be advised to have regular blood tests and physical check-ups.

Once your symptoms get better you will need further testing to check that you are free of the virus and have not developed chronic hepatitis B.

Chronic hepatitis B

If you have chronic hepatitis B, you will be symptom-free for much of the time.

However, you may need to take medication, possibly for many years, to prevent liver damage. You may also need regular tests to assess the state of your liver. This might include blood tests, an ultrasound and possibly a liver biopsy. This is to assess whether the virus is currently damaging the liver and how much damage has been done.

Medication

The main treatment for chronic hepatitis B is antiviral medication, which helps stop the hepatitis B virus from causing liver damage.

Most patients do not require treatment, as although the virus is present in the body, it does not always damage the liver. In some patients, their immune system suppresses the virus without causing damage. However if there is evidence of ongoing liver damage then treatment is required.

There are now very effective medications that can suppress the virus over many years and this can slow down the damage that is being done to the liver, allowing the body to repair this. However, it is unusual for this treatment to clear the virus permanently.

It is very important that you take your treatment as prescribed, even if you feel well or are finding side effects troublesome, as stopping treatment early can lead to drug resistance and could also lead to liver damage. Always speak to your doctor before you come off these drugs.

The two main types of antivirals are described below. You may require a combination of these.

Nucleoside analogs

Nucleoside analogs are a type of antiviral medicine that prevent the genetic code of the virus from being copied into healthy cells.

The two most commonly used nucleoside analogs in this country are called tenofovir and entecavir.

They have the advantage that serious side effects are rare.

Tenofovir

Tenofovir is available in tablet form which should usually be taken with food.

Side effects of tenofovir include:

  • diarrhoea 
  • feeling sick
  • being sick
  • skin rash
  • feeling weak
  • dizziness
  • in rare cases, kidney problems 

Entecavir

Entecavir is available in liquid form. The medication will also come with a special measurement spoon you can use to measure out your dose.

Side effects of entecavir include:

If you feel dizzy, avoid driving or using tools or machinery.

Lactic acidosis and nucleoside analogs

A rare but serious side effect that can occur with all types of nucleoside analogs is that the medication can cause a build-up of lactic acid in your blood. This is known as lactic acidosis and is potentially serious if left untreated.

Initial warning signs and symptoms of lactic acidosis include:

  • feeling very weak or tired
  • having unusual muscle pain
  • breathing difficulties
  • having stomach pain along with feeling or being sick
  • feeling usually cold, especially in your arms and legs
  • feeling dizzy or light-headed
  • having a fast or irregular heartbeat

If you experience any of these warning signs and symptoms, contact the doctor in charge of your care for advice.

Pegulated Interferon alfa

Pegulated Interferon alfa can be used in the treatment of hepatitis B where there are very high levels of the virus. It stimulates the immune system (the body’s defence against infection) to attack the hepatitis B virus.

The medication is usually given by injection once a week over four-to-six months.

It's common to experience flu-like symptoms, such as a high temperature and muscle and joint pain, after beginning to take pegulated interferon alfa. Taking paracetamol can often help relieve these side effects and they should get better with time.

However, in some people pegulated interferon alfa can cause a wide range of persistent and unpleasant side effects. This means that treatment needs to be withdrawn and an alternative antiviral will need to be used.

If you start to feel any uncomfortable side effects of interferon alfa, tell your doctor.

Regular monitoring

If you have chronic hepatitis B, the state of your liver will need to be regularly monitored via blood tests to see how well you are responding to treatment.

Other tests may include an ultrasound scan – which is used to check for any abnormalities on the surface of your liver

The frequency of these other tests may depend on the results of your blood tests.

Preventing the spread of hepatitis B

While the medications mentioned above can slow the spread of chronic hepatitis B and hopefully prevent complications such as cirrhosis, they cannot cure the infection. This means you can still pass hepatitis B on to other people.

You should avoid having unprotected sex with someone, including anal and oral sex, unless you are sure they are immunised against hepatitis B.

If you are an injecting drug user, never share your needles with other drug users.

You should also take some sensible precautions to avoid the spread of infection, such not sharing toothbrushes or razors with other people.

Read more about preventing hepatitis B.

Page last reviewed: 15/11/2011

Next review due: 15/11/2013

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For some people with severe liver disease, such as cirrhosis, having a liver transplant is an option.

However, the virus may infect the new liver and can sometimes cause more disease in future.

For more information, see  liver transplant.

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