Hepatitis B: When is treatment mandatory?

Vietnam is a country with a high rate of hepatitis B patients. Although more drugs have recently been introduced to treat chronic hepatitis, resistance is also common. Therefore, it is necessary to effectively use hepatitis B drugs and understand which cases require treatment.

1.1. In case of needing medication, hepatitis B drug should be used in the following cases:
There are obvious symptoms of hepatitis B, such as: Yellow skin, yellow eyes, fatigue and loss of appetite; HBsAg surface antigen test result is positive: Proving viral hepatitis; Endogenous antigen HBeAg positive: Indicates viral hepatitis is multiplying; Liver enzyme ALT-alanine aminotransferase: Increase 2 times or more; Hepatitis B virus (HBV-DNA) quantitative test to determine whether blood contains complete virus: Greater than 2x103 IU/ml.

1.2. If a healthy person is a carrier of the disease, then there is no need to take medicine to treat hepatitis B. In addition, drugs are not required for:
People who are “immune tolerant”; The patient has ever had chronic hepatitis B; People with inactive hepatitis B: The virus once activated silently, then stopped. However, these cases must be closely monitored by clinical examination and periodic testing, when necessary, immediate intervention measures should be applied.

2.1. Indications For patients with chronic hepatitis B, the doctor will prescribe mandatory treatment when all the following factors are present on a case-by-case basis.
Case 1, patient has test results:
HBsAg positive; HBeAg positive; HBV-DNA quantification per 100,000 copies/ml; Liver enzymes 2 times higher than normal; Clinical symptoms such as: Fatigue, jaundice, digestive disorders, pain in the lower ribs, ... Case 2, the patient's test results were:
HBsAg positive; HBeAg negative; HBV-DNA quantification above 10000 copies/ml; Liver enzymes are 2 times higher; Clinical symptoms are present. However, in fact, patients will also be prescribed a treatment regimen that is appropriate for their age and physical condition.

2.2. Treatment goals The goals of hepatitis B treatment are:
Inhibiting the growth of the virus; Reduce the concentration of virus in the blood; Control the symptoms of the disease; Lower liver enzymes; Prevent the risk of cirrhosis and liver cancer. 2.3. Drugs to treat hepatitis B In patients who have just been diagnosed with hepatitis B but have never been treated with anti-HBV drugs before, one of two groups of drugs can be chosen:
Peg-interferon injection. alfa 2a subcutaneously, dose 180μg/week, injection time for 48 weeks. The drug is preferred for:
Young women who wish to become pregnant; HBV-DNA viral concentrations below 10 million copies/ml; Or requested by the patient. Oral medications: The two drugs that are preferred because of low rates of resistance are:
Entecavir (ENT) 5mg/day; Tenofovir (TDF) dose 300mg/day. Also available:
Lamivudine (LAM) at a dose of 100mg/day; Telbivudine (LdT) at a dose of 600mg/day; Adefovir (ADV) at a dose of 10mg/day. 2.4. Duration of treatment In case the patient has a positive HBeAg test result, the drug must be continued for at least 12 months. Discontinue when:
HBV-DNA below 10000 copies/ml; Presence of HBeAg negative or presence of anti-Hbe; Conversely, if the patient has a negative HBeAg test result, the duration of treatment will be more difficult to determine because stopping the drug will be very prone to relapse. In this case, treatment can be continued until HBsAg is lost.

3.1. No response to antiviral drugs The doctor may prescribe Lamivudine in combination with Tenofovir if the patient falls into 1 of the following 2 cases:
After 6 months of treatment with Lamivudine 100mg/day, but the HBV-DNA level remains over 1000 copies/ml; After 1 year of treatment with Adefovir 10mg/day, the HBV-DNA level remains above 100,000 copies/ml or the viral concentration ranges from no decrease to an increase of more than 10 times compared to pre-dose. 3.2. Complicated cirrhosis with compensated cirrhosis If the HBV-DNA level is above the detectable threshold, treatment with:
Peg-interferon alfa 2a injection or classic Interferon alfa: 5ml daily or 10ml each time, injection 3 times / week for a period of 6 - 12 months; Oral medicine Entecavir, Tenofovir: Dosage as stated in section 2.

3.3. Complications with decompensated cirrhosis are contraindicated in this case, and treatment with injectable drugs should only be applied with oral regimens of Entecavir and Tenofovir. Note that the dose should be adjusted when the patient's creatinine clearance is less than 50ml/min.
3.4. The patient is a child over 12 years old The treatment regimen for hepatitis B is prescribed as:
Use Lamivudine at a dose of 3mg / day (do not use more than 100mg per day); Injectable Interferon alfa 2a no more than 10ml / injection and treatment 3 times / week. 3.5. The patient is a woman who is taking medication and is pregnant. Should continue treatment with approved drugs such as Tenofovir, Telbivudine; Adefovir, Lamivudine, and Entecavir are not recommended; Contraindicated for use in pregnant women. 3.6. Other cases If the patient accepts to adhere to the long-term treatment regimen, it is necessary to consider applying antiviral drugs in the following cases:
Liver enzymes increase more than 10 times normal; HBV-DNA levels above 1 million copies/ml; Family history of hepatitis B virus.

The doctor may consider a liver biopsy, measure the degree of liver damage or do a test to assess the degree of fibrosis to provide an accurate hepatitis B treatment regimen.
In general, hepatitis B is a fairly common disease in the community today. Therefore, when there are suspicious symptoms, the patient needs to go to the doctor immediately to get an early diagnosis in order to prescribe timely and appropriate treatment according to the prescribed regimen according to each medical case. Note, hepatitis B patients must be treated for a long time under the supervision and monitoring of doctors to ensure effectiveness and safety, as well as prevent the risk of cirrhosis complications and liver cancer.
Currently, Vinmec International General Hospital has Hepatobiliary Screening packages, which help detect Hepatitis Virus at an early stage even when there are no symptoms. In addition, the comprehensive hepatobiliary screening package helps customers:
Assess the liver's ability to work through liver enzyme tests; Evaluation of bile function; vascular nutrition; Early screening for liver cancer; Perform tests such as Total blood cell analysis, blood clotting ability, screening for hepatitis B, C Assessment of hepatobiliary status through ultrasound images and diseases that have the potential to affect liver disease/cause liver disease. more severe liver disease In-depth analysis of parameters to evaluate hepatobiliary function through laboratory, subclinical; the risk of affecting the liver and early screening for hepatobiliary cancer

To register for examination and treatment of hepatobiliary diseases at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
SEE ALSO:
Hepatitis B medicine: What you need to know Diagnosis and treatment of hepatitis B according to the guidelines of the Ministry of Health Things to know about Hepatitis B virus