Hepatitis B: Drug Therapy

Therapeutic targets

  • In chronic hepatitis B, therapy should be directed toward normalization of transaminases (specific liver enzymes; GOT, GPT) and the lowest possible viral load (<300 copies of HBV DNA/ml).
  • Partner management, i.e., infected partners, if any, must be located and treated (contacts must be traced depending on the estimated time of infection or up to two weeks before the onset of jaundice).

Therapy recommendations

  • Acute hepatitis B:
    • Usually no treatment; it cures 99% spontaneously.
    • If drop in Quick value (parameter of blood clotting) below 50% or restriction of liver synthesis: therapy with inhibitors of HBV DNA polymerase.
    • In fulminant course: Treatment with a nucleoside or nucleotide analogue (antivirals).
      • In case of low HBV DNA: lamivudine
      • If HBV DNA is high: entecavir or tenofovir
  • Chronic hepatitis B: antiviral therapy.
    • Interferon or nucleoside or nucleotide analogues.
    • First check whether interferon α-therapy is possible/meaningful (defined therapy duration of usually 48 weeks).
    • If interferon α-therapy is not possible or the patient has not responded, nucleoside or nucleotide analogues are used.
  • If necessary, symptomatic therapy (antiemetics/anti-nausea and anti-nausea drugs).
  • Post-exposure prophylaxis (PEP) [see below].
  • See also under “Further therapy”.

Antiretroviral drugs

Antiretroviral drugs act against retroviruses, which is a certain subgroup of viruses, which include the viruses responsible for hepatitis B.A distinction is made between the following groups of antiretroviral drugs:

  • Reverse transcriptase inhibitors
  • Nucleoside analogues
  • Protease inhibitors
  • Fusion inhibitors

Lamivudine, a nucleoside analogue, is used for complicated acute and chronic hepatitis B. It is also used for chronic hepatitis. It is relatively well tolerated and is therefore widely used. Side effects include headache or nausea and/or vomiting.

Interferon alpha

Interferons are substances that trigger various effects within the cell that have an antiviral effect. They are used for hepatitis B and hepatitis C. Flu-like symptoms are more frequently observed as side effects. Liver parameters may also be elevated.

Postexposure prophylaxis (PEP)

Postexposure prophylaxis is the provision of medication to prevent disease in persons who are not protected against a particular disease by vaccination but have been exposed to it. Indications (areas of application)

  • Injuries with potentially contagious (pathogen-containing) objects such as needles (needlestick injuries (NSV)) or scalpels.
  • Blood contact with mucous membrane or non-intact skin.
  • Newborns of HBsAg-positive mothers or of mothers with unknown HBsAg status (regardless of birth weight).

Implementation

  • In case of injuries with potentially contagious objects:
  • According to maternity guidelines, all pregnant women should have their serum tested for HBsAg after the 32nd week of pregnancy (SSW), as close to delivery as possible.
  • Newborns of hepatitis B-positive mothers are given a dose of hepatitis B immunoglobulin (antibodies to hepatitis B virus) and the first dose of HB vaccine immediately after birth. Complete basic immunization is then carried out in the first year of life.

Hepatitis B immunoprophylaxis after exposure in relation to current anti-Hbs levels.

Current anti-HBs level Requires the administration of
HB vaccine HB Immunoglobulin
≥ 100 IU/l No No
≥ 10 to < 100 IU/l Yes No
<10 IU/l or not to be determined within 48 h and anti-HBs was ≥ 100 IU/l at an earlier time point Yes No
And anti-HBs was never ≥ 100 IU/l or unknown. Yes Yes