Just Diagnosed with Hepatitis B Virus?



Just Diagnosed with Hepatitis B Virus?Accessing Best Care Information Bookletby Paul Desmond .uk 11/28/2015 The Hepatitis B Virus… …..may or may not cause symptoms. Following infection, 5-10% of infected adults and up to 90% of children develop the persistent infection called chronic hepatitis B. Many people with chronic hepatitis B remain well, but some over 20 or more years, develop serious liver problems. The virus is mainly passed on via wounds at birth or in childhood when the immune system is weak, across Africa and Asia a huge risk remains from contaminated healthcare. In adult’s sexual contact, blood spills and sharing needles to inject drugs are common causes. The Virus can cause serious Liver Disease.What does Hepatitis B do?Hepatitis means inflammation of the liver. One virus that causes hepatitis is called the hepatitis B virus. Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver, if left undiagnosed for decades to middle age and old age it can cause cirrhosis and liver cancer. There are excellent medications that can completely control hepatitis b now.How common is Hepatitis B?In the UK about 1 in 120 people are thought to have lasting hepatitis B infection, naturally with millions migrating from Pandemic Areas without safety screening, the UK total has both grown in scale and more importantly tripled in terms of undiagnosed numbers over the last 2 decades. Worldwide, it is very common with hepatitis B infecting 1 in 20 humans on Earth. For example, in most of Asia and Africa more than 1 in 30 people have chronic hepatitis B infection and 1 in 3 humans catch it! In the UK 12,000,000 citizens are at high risk and recommended for safety screening and vaccination.What are the symptoms and how does hepatitis B progress?It is helpful to think of two phases of infection with hepatitis B virus. The first six months phase when you are first infected and after which 95% of adults clear and become immune and a constant infection phase when the virus is not cleared and remains.New infectionsIn about 70% of cases symptoms are unnoticed; in particular babies infected during childbirth usually have no symptoms. In more than 9 out of 10 babies, the virus remains long-term. When occurring symptoms usually develop after a 8-16 weeks, as the immune system brings the virus under control this happens for 95% of adults. Symptoms include: feeling sick, vomiting, abdominal pains, fever and feeling generally unwell. You may become jaundiced (go 'yellow'). With jaundice due to hepatitis your pee goes dark and your poohs may go pale. Very rarely, a ('fulminant') hepatitis develops from these symptoms, which is life-threatening.Lasting infection – the diagnosed and treated seldom progress to serious liver diseaseA chronic hepatitis B infection is when the infection lasts for longer than six months. Of those people who develop chronic hepatitis B infection and do not know over 30 -50 years:Ultimately 10-25% of the undiagnosed may die.Damage from unsuspecting, often mild alcohol or medicine use is commonly implicated.With today’s medical advances no one diagnosed without liver disease should ever progress to it due to hepatitis b..30-35% develops persistent liver inflammation (sometimes called 'chronic active hepatitis B'). Symptoms include: muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice and depression. Symptoms vary in severity and some people have liver inflammation without having any symptoms.20-30% develops cirrhosis. Cirrhosis is like a 'scarring' of the liver which can cause serious problems and 'liver failure' when it is severe. Cirrhosis usually takes many years to develop after being infected with hepatitis B10-15% dies from liver cancer or liver failure after 20-50 years.How is hepatitis B diagnosed and assessed? Do arrange insurances and?finances before a test. A simple blood test can detect if you are infected with the hepatitis B virus. If infected, other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver. For example:A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly and therefore more likely to cause liver damage).Blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. An ultrasound scan of the liver is recommended.A biopsy (optional) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and cirrhosis. A blood test can also be performed to show if you have immunity to hepatitis B.Other tests may be done if cirrhosis or other complications develop.There are other tests which assess the development and severity of cirrhosis.Just Diagnosed?Unfortunately in the UK, GP’s and NHS Choices are very poorly equipped for Hepatitis discussions. Poor literature, no Atlases of the 400 million infected, no test risk posters, have been given them. GP’s often look on this mainly child Virus as a kind of Junkie & Sex Disease, as per the information they have. So many patients get false notions and fail to contact experienced help lines or get important referrals to a Liver Specialist, sometimes for years. So here is advice from patients and mums who’ve experienced being diagnosed and adjusting.General Emotional AdviceTry not to feel guilty, Remember 1 in 3 humans have caught this bugDon't feel infectious teach loved ones vaccination, safe sex and blood hygiene Many patients find HBV makes them live longer, healthier lives Try to learn about Hepatitis B, and how it is managed.Understand your level of infection, if it is inactive and low risk it is good to know quickIf your liver is fine, you have a life?of health and happiness to plan for, don't forget. Who to tell?Do not announce your infection; some people may react badly with ignorance. Try to let knowledge of your infection make a few relationships stronger Take time to understand the virus first You will need to teach people what HBV is, very few know. This is the one where vaccination is far the most important precaution. Diet and alcoholMost people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. However fried foods or oily and “ghee” type foods are all not good and can inflame the liver. If you already have liver inflammation, both obesity and alcohol increases the risk and speed of developing cirrhosis. Clinical studies have repeated shown that long term HBV infection and even moderate drinking can quickly result in Cirrhosis. Real caution needs to be exercised with many, many medications also, it is important your doctors consider your liver status when prescribing each and every time.It is important to note that most HBV infections do not lead to cirrhosis or liver cancer, even after decades, this is clearly lifestyle related. For some it is only acute reactions to alcohol or medication or maternity testing that ever gets them diagnosed.What is the treatment of hepatitis B?People with chronic hepatitis B usually do not need treatment to stop or reduce the activity of the virus. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:Antiviral drugs. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, telbivudine, and entecavir. Your doctor will discuss these in more detail with you as the drug used can vary between people. A combination of antiviral drugs is sometimes used. Interferon. This drug is similar to a substance produced in your body which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.Drug treatment may be continued for many years. Side-effects with these treatments can occur. You will be monitored regularly while you are taking the treatment, which includes blood tests. Some people need to change their treatment, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to the treatment, which means that it does not work so well. If this happens to you then it is likely you will have to change the treatment you are taking.Liver transplantFor some people with advanced cirrhosis, liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting hepatitis B infection.How can you get hepatitis B?During MaternityWorldwide, common ways the virus is passed on is during unvaccinated childhood and maternity and contaminated healthcare. This is very common in some parts of the world where many people are infected with this virus. However many things can be done to avoid this. All women in the UK are now tested for hepatitis B when they are pregnant.From Person to Person The main ways in which people in the UK become infected include the following:From infected blood, especially in childhood. You only need a tiny amount of infected blood to come into contact with a cut or wound on your body to allow the virus to enter your bloodstream, multiply and cause infection 8-16 million people a year are infected via re used medical syringes in the third world.Sharing needles and/or any injecting equipment (for example, spoons, filters water for injection) to inject illegal drugs. NHS & EU Patients who had a blood transfusion or blood products before 1992 were at risk of hepatitis B. Overseas patients are often at greater risk across Africa and Asia. From needle stick accidents where the needle was used on an infected person.Having unprotected sex with an infected person. Even having oral sex can transmit hepatitis B. (Note: 80% of people with hepatitis B do not know)There is a risk of contracting the virus from sharing razors, tools and other such items which may be contaminated with blood. The virus can actually live outside the body for more than one week.From using equipment which is not sterile for dental work, medical procedures, tattooing, body piercing, etc.Other bodily fluids, such as semen and vaginal secretions contain the virus in infected people.A bite from an infected person, or if their blood spills on to a wound on your skin, or on to your eyes or into your mouth.The virus is not passed on during normal social contact such as holding hands, hugging or sharing cups or crockery. Hepatitis B is a very infectious disease, worldwide 1 in 3 catch it.Ultimately a main reason people get infected is they forget their Vaccination, we owe it to our Species future to eradicate this disease with it.Can hepatitis B be prevented?VaccinationA vaccine is available to protect against hepatitis B. This should be offered to anyone who is at increased risk of being infected with the hepatitis B virus. For example, First Aiders and Emergency Workers or persons from Pandemic areas such as Africa, Eastern Europe or Asia. Post-exposure preventionIf you are not immunised and have been exposed to the virus, you should see a doctor immediately. (For example, if you are a healthcare worker and you have a needlestick injury.) You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.Preventing infection in new-born babies at riskAll pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of vaccine and immunised straight after birth. With this treatment and some of the newer drugs arriving, there is a comprehensive set of precautions in place to prevent infection developing in the baby.If I am infected, how can I prevent passing on the virus to others?If you have a current hepatitis B infection you should:Make sure partners and children are vaccinatedMake sure living companions, contact sports friends etc are vaccinated too.Teach blood hygiene. If any of your blood spills on to the floor or other surfaces following an accident, make sure it is cleaned away with bleach.Cover your cuts immediately with a dressing. Encourage others to do the same.Wear latex gloves whenever dealing with woundsNever share razors etc, and bleach clean items (work tools) that may be contaminated with blood.Do not share any illegal drug injecting equipment such as syringes, drug brewing cups, foil wraps, blood stained snorting tubes etc.Do not donate blood or semen or carry a donor card.Use condoms until they have been fully immunised and have been checked to see that the immunisation has worked by a blood test.Avoid tattoos and piercingWhat does the Liver do?In essence the liver eats your dinner and makes you and also heals you.The Liver has many functions which include:Storing glycogen (fuel for the body) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.Helping to process fats and proteins from digested food.Making proteins that are essential for blood to clot (clotting factors).Processing many medicines which you may take.Helping to remove or process alcohol, poisons and toxins from the body.Making bile which passes from the liver to the gut down the bile duct. Bile breaks down the fats in food so that they can be absorbed from the bowel.Further help and information contact the Hepatitis B Positive Org UK Web: .uk begin_of_the_skype_highlighting???? Tel: 0800 206 1899?? Email:gettestedforhepatitis@ReferencesCooke GS, Main J, Thursz MR; Treatment for hepatitis B. BMJ. 2010 Jan 5;340:b5429. doi: 10.1136/bmj.b5429.Management of the Viral Hepatitides A, B and C, British Association for Sexual Health & HIV (2008)Liaw YF, Chu CM; Hepatitis B virus infection. Lancet. 2009 Feb 14;373(9663):582-92. [abstract]Dienstag JL; Hepatitis B virus infection. N Engl J Med. 2008 Oct 2;359(14):1486-500.Pungpapong S, Kim WR, Poterucha JJ; Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc. 2007 Aug;82(8):967-75. [abstract]Hepatitis B - entecavir, NICE Technology appraisal (August 2008); Entecavir for the treatment of chronic hepatitis BHepatitis B telbivudine,NICE Technolog Appraisal (August 2008);Telbivudine for the treatment of chronichepatitis B???STOP 34 million people have HIV 400 million have inherited HBV210 million have transfusion HCV CAUTIONHIV, HBV and HCV Can live in spilt blood And infect via contact With an open woundUSE”Premiership Blood Hygiene”Active plastering of all wound Gateways using gloves, thenBleach Kill the Spill & Virus BECAUSE1 in 10 people on Earth and1 in 75 people in the UK Bleed a blood virus now. Hepatitis B Vaccination (at a glance) Immunisation schedule Source schedule The standard course of immunisation is 3 injections over 6 months on Day 1, Day 30, Day 180.Adults who need protection quickly can have a schedule over 28 days. Day 1, 7, 28. The vaccine is administered intramuscularly, usually into the deltoid muscle3, a booster at 1 year is recommended. It can be used in those who are immunocompromised, as with HIV infection, but a higher dose may be required or extra booster injections, with HIV beware of CD count drop.Babies have 5ml half doses at Day 1, Day 30 and Day 60 with booster on 12 months.An accelerated course over 2 months is possible for combined hepatitis A and B vaccines.The vaccine should be given into the deltoid region or anterior thigh in babies. It is less effective if given into the buttock. It is quite possible that a course may give lifelong immunity,4 but for health professionals one further booster at 5 years* is recommended. Antibody titres should be tested in health professionals 1 to 4 months after the primary course.A titre above 100 mIU/ml is regarded as adequate.Around 10-15% of adults fail to respond to three doses of vaccine or respond poorly.1Poor responders with titres of 10 to 100 mIU/ml should have a booster and those with a titre below 10 mIU/ml should repeat the course.Those over 40 years old, who are obese or who smoke are more likely to fail to respond.Alcoholics are also reported as having lower seroconversion rates, particularly those with advanced liver disease.Patients who are immunosuppressed or on renal dialysis may also respond less well and require larger or more doses of vaccine.Failure to produce any antibody after 2 complete courses should not be seen as necessarily meaning no immunity, as immunity to the disease is largely cell-mediated rather than by antibody.*Of a thousand people vaccinated and having no boosters 3 became infected after 10-15 years. 5 years is chosen due to safety, health care workers are not suddenly “at risk” after 5 years. Post-exposure management Post-exposure prophylaxis (PEP) involves giving hepatitis B vaccine and possibly immunoglobulin too if required.Immunoglobulin is given at a different site and it does not reduce the immune response to the vaccine.If the status of the source is unknown assume infection.PEP may be indicated even if the exposed person has received hepatitis B vaccine previously.It should be given within 48 hours and certainly no later than 7 days after exposure.The incubation period of the disease is 40 to 160 days.If the site of exposure is a needlestick injury, cut or abrasion, the site should be washed immediately with soap and water. It is indicated for babies born to mothers who are chronic carriers of hepatitis B virus or to mothers who have had acute hepatitis B during pregnancy. More details about PEP can be found in 'The Olive Book’ and ‘Guidance for Clinical Healthcare Workers from the DH.Blood tests and Investigations for Liver Function Some of the standard or routine blood tests that your doctor will order to check “liver function” are in reality only able to detect liver damage. These tests may not be sensitive enough to accurately reflect whether your liver is functioning at its optimum level. These tests will usually be abnormal in significant liver disease or liver distress; however, they can still give normal readings in some cases of mild liver disease. This is why imaging tests of the liver and gallbladder, such as ultrasound scans or CAT scans or MRI scans are important. These imaging tests can determine the degree of liver disease and if there are any tumours, cysts, gallstones or fatty accumulations which change the texture of the liver. Healthy ranges for Blood tests for Liver FunctionALT0 - 45 U/LGGT0 - 45 U/LAST0 - 45 U/LALP30 - 120 U/LBILIRUBIN0 - 20 U/L or 0.174 to 1.04 mg/dLALBUMIN38 – 55g/L or 3.8 to 5.5g/dL AFP20 – 32g/L or 2 to 3.2g/dLALT (alanine aminotransferase), is elevated showing inflammation of the liver.GGT (gamma glutamyl transpeptidase) is elevated in those who use alcohol or toxins.AST (aspartate aminotransferase) is elevated in heart, muscle and liver diseases.ALP (alkaline phosphatase) is elevated in many types of liver and non liver disease.BILIRUBIN is elevated, the patient may have a yellow colour skin and eyes, jaundice.ALBUMIN falling levels of blood albumin show deteriorating liver function.AFP (Globulin protein). Elevated usually mean excessive inflammation in the liver and/or immune system. Very high levels may be seen in some types of cancers.Ultrasound scans of the liverUltrasound scans are very useful to detect changes in the liver. Damage to liver cells by fat, toxins or infections etc, causes inflammation, which can lead to hard scar tissue or fibrosis. A liver that has developed widespread fibrosis is firmer, and if the condition progresses to cirrhosis, the liver can become almost rock-hard. Detected early, fibrosis of the liver can in many cases be reversed.Liver BiopsyThis is the procedure where a needle is inserted through the abdominal wall into the liver to remove a tiny sample of the liver tissue. The pathologist is able to see if the liver cells are healthy, if there is a lot of scar tissue destroying the liver architecture. Liver biopsy is considered to be an accurate way to determine if your liver tissue looks healthy, fatty or inflamed, or if you have cirrhosis. Scarring and fibrosis is scored 1 to level 6Communities need “Disease Sensitive Counseling”The Hepatitis Pre-Test Discussion Should ask for informed consent for testing by the patient after explainingPrinted HVC/ HBV information about the annual global deaths due to poor diagnosis. The value of knowing liver status. Assessment of Infection Risks and or Symptoms that need testing, Explanation of risks for HBV/HCV being 1 in 3 humans rmation about confidentiality and the notification process. Very rarely insurers and employers may access this information, so arranging insurances or work issues if you are e.g. a surgeon or a boxer can be important.On Occasion it is necessary, to assess support for a result, e.g. children, mentally ill and the elderly, and to reduce infection risks, e.g. vaccination/safer injecting.The Hepatitis Post-Test Discussion Should give the test result in a manner that is confidential, sensitive and appropriate to mental state, personally, coveringAn Understanding of HCV / HBV’s Disease Journey. With HCV explain it is not a sex disease but a Super Bug Pandemic affecting 200 million A Liver Friendly lifestyle, explain how HCV/HBV kills with pills or alcohol The Basics of both HBV Vaccination and Blood hygiene precautions, people need to use plasters and bleach spills. HBV also requires safe sex as that virus is in sexual fluids Medical Referral to a liver specialist and a source of disease information, such as the Hep C Trust or Hep B Foundation, for the person’s discretion.Assessment of mental state, I’ve seen people diagnosed with liver cancer and months to live and be very sensible and people diagnosed with a normal life expectancy and no damage have a breakdown and need a psychiatrist. On Occasion it is necessary to arrange Rehabilitation or Psychological counseling or therapy.“Disease Sensitive Counseling” Treatment Plans GP & Support Group Do’s and Try Not To’sDo encourage liver good life, diet, attitude, vaccination, abstinence, educationDo print HBV Booklet with every diagnosis.Do vaccinate all partners and relatives (work sport colleagues often)Do support the unhealthy livers with Treatment and any constant side effectsDo make clear HBV is only caught by those forgetting their vaccineDo assume 80% of presenting infections are unavoidableDo not prescribe long term unless audited monitored riskDo mention 21 units creates cirrhosis tooDo mention obesity doubles the dangerDo explain the healthy livers may not need treatment highlight they are healthy Do not assume IDU or sex risks initiallyDo assume totally innocent work, birth or childhood risks as often as you canDo not call HCV sexual only transfusableDo try, not mother to child, but Maternity Unit infectionsDo encourage Premiership Blood HygieneDo try to use simple terms for Hepatitis B results HBeAgGot it replicating (often high risk yet quickly manageable)HBV DNA (high) Got it replicating(often high risk yet quickly manageable)HBsAgGot it (often low risk and often left untreated)Anti-HBc IgmFighting it(6 month window of recent infection)Anti HBs/HBeCleared it (had hbv cleared it and are immune)100 anti per mlImmunised for it (had vaccination and are immune)Liver Illnesses at mean age 30 years undiagnosed with HBV/HCV The percentages of long term HBV/HCV patients having these ailments are from published studiesGall stones, 17% HCVonly Cirrhosis, 25% Fibrosis, 35% Liver failure, 5%Liver Cancer, 10% Poor LFT’s,40% Overview of Illnesses Linked with Viral Hepatitis- 2009The hepatitis B/C virus’s mainly affect the liver, but other illnesses are associated with them. These mainly affect the skin, eyes, joints, immune system, nervous system and kidneys. Some of these conditions– Cryoglobulinemia, for example – are somewhat more common and well-documented, while others are infrequent or their association with hepatitis has not yet been proven. Several studies have found that between 70-74% of patients experience non liver conditions. Common highlights conditions that have called the helpline twice in one day,Speech marks highlight common patient or counselor statements.Daily “HBV & HCV can affect the skin.” “And cause painful and wearying conditions.”Common Peripheral Neuropathy Increased Sjogren?s syndromeCommon Pruritus 15%Increased Lichen myxoedematosus Common Arthralgia Increased Vitiligo Common Fatigue Increased Porphyria Cutanea TardaCommon Fibromyalgia Increased Thyroid Disease hyperthyroidism Common Arthritis poly and monooligoarthritis.Mooren Corneal Ulceration Common Persistently high ALTs 40%Paresthesia Spider NeviCluster Headache Rare Lichen PlanusWeekly “HBV & HCV affects the veins, kidneys and blood and their many functions”. Increased ThrombocytopeniaIncreased Immune ThrombocytopenicIncreased Systemic LupusIncreased VasculitisIncreased Insulin Resistance Rare Hypertrophic CardiomyopathyRaynaud?s SyndromeNeutropeniaRare DiabetesRare Behcet?s DiseaseCommon CryoglobulinemiaRare Cerebral VasculitisMembranoproliferative GlomerulonephritisIncreased Membranous NephropathyMonthly “HBV & HCV can affect the lungs.” & “HBV & HCV can cause non liver cancers.” Increased Waldenstrom Macroglobulinemia Multiple MyelomaIncreased Non-Hodgkin?s LymphomasKidney Cancer 0.6% Asthma Idiopathic pulmonary fibrosis Chronic Obstructive Pulmonary DiseaseBile duct and NHL Cancer 1%It is important to remember that the vast majority of people with hepatitis may never experience the more severe types of these non liver illnesses above. The great shame is so often these conditions are treated without any thought they may be Hepatitis driven by General Practitioners and Hospital Specialists as well as support groups and patients.One caller had nine of the above ailments plus cirrhosis, fibrosis and viral hepatitis.Factors below and Long Term Non Diagnosis occurred in 85% of Deaths* Hepatitis, Alcohol and Binge Drinking.Alcohol is approximately two to four times more destructive to the liver of a person with viral hepatitis. 60% of those drinking 21 units were cirrhotic after 5 years.Alcohol abuse is often fatal to the undiagnosed.One helpline caller had quintupled his ALT score with a weekend binge.Hepatitis, Prescriptions and Binge Medicating.The following list is a guide to medicines used to treat many medical conditions. The list does not include all medicines that may affect the liver systems. If a medicine you are taking is not listed here, check with your doctor. One helpline caller noted an ALT score of 625 after 3 months of paracetamol.Acetaminophen Paracetamol AntacidsAntibiotics AnticholinergicsAnticonvulsantsAntihypertensivesAntituberculins Calcium channel blockersChlorpromazine ColchicineIron LaxativesNitrates Nonsteroidal-anti-inflammatoryPotassium chloride QuinidineTheophylline VitaminsHepatitis, Obesity, Diet and Binge Eating.While not as yet totally defined, many factors influence the rate of disease progression. Diet likely plays an important role in this process, as all foods and beverages that we ingest must pass through the liver to be metabolized. In particular obesity and fatty liver disease can further damage the liver.Fat and Hepatitis. Fatty fried foods are very hard for the liver do digest, they frequently cause pain to longer term patients, they are also complicit in creating fatty liver so should be taken rarelyIron and Hepatitis. The liver plays an important role in the metabolism of iron since it is the primary organ in the body that stores this metal. The average diet contains about 10- 20 mg of iron. Only about 10% of this iron is eliminated from the body. Patients with chronic hepatitis sometimes have difficulty excreting iron from the body. This can overload of iron in the liver, blood, and other organs. Excess iron can be very damaging to the liver. Patients with chronic hepatitis whose serum iron level is elevated, or who have cirrhosis, should avoid taking iron supplements and restrict the iron rich foods in their diet, such as red meats, liver, and cereals fortified with iron.Protein and Hepatitis. Adequate protein intake is important to build and maintain muscle mass and to assist in healing and repair. Protein intake should be between about 60 – 120 grams a day in patients with hepatitis, unless encephalopathy occurs. Encephalopathy is an altered mental status. It has been shown that restriction of the diet of animal protein and maintaining a total vegetarian diet, helps reverse this condition and improve mental capacity. Advanced scarring of the liver or cirrhosis can lead to fluid in the abdomen referred to as ascites.Salt and Hepatitis. Patients with hepatitis who have ascites must be on salt restricted diets. Every gram of sodium consumed results in the accumulation of 200 ml of fluid. The lower the salt, the better this fluid accumulation is controlled. While often difficult, sodium intake should be restricted to 1000mg each day, and preferably to 500 mg per day. For example, one teaspoon of table salt - 2,325 mg of sodium! Most fast food restaurants are a no no. Meats, especially red meats, are high in sodium a vegetarian diet may often become necessary. Patients with hepatitis without ascites are advised not to overindulge in salt intake, although their restrictions need not be as severe. Helpline Reports 1st June to 1st November 2011. (8 and 1) The Palette of HBV Treatments – these are tailored to each patient’s needsThe goals and aims of HBV treatment are to lower infectivity and slow liver damage. This is because no drug is effective at removing the virus. Hepatitis B HBsAG on your test result means you are infected but you are a low infection risk and HBeAG means you are infected and the virus is replicating and you are a high infection risk.Chronically infected individuals with persistently elevated ALT’s, a marker of liver damage, and high e antigen or just HBV viral loads are candidates for therapy. Several medicines treat hepatitis B. If you do not need to start treatment immediately, you will be monitored over time to know when hepatitis becomes more active. Once you start treatment, you will have regular blood tests to see how well the treatment is working and to detect side effects or drug resistance. Monitoring will continue after finishing treatment to detect signs that the infection has come back. Each patient may have a different set of needs or treatments according to the factors and their individual health, further these medicines evolve and improve rapidly, being on a trial is quite normal in this field of medicine.Lamivudine — Lamivudine (Epivir-HBV?) is effective in decreasing hepatitis B virus activity and ongoing liver inflammation. It is safe in patients with liver failure and long-term treatment can decrease the risk of liver failure and liver cancer. (See "Lamivudine monotherapy for chronic hepatitis B virus infection".)Lamivudine is taken by mouth, usually at a dosage of 100 mg/day. The major problem with lamivudine is that a resistant form of hepatitis B virus (referred to as a YMDD mutant) frequently develops in people who take lamivudine long term. Other medicines are available that are less likely to cause resistance.Adefovir — Adefovir (Hepsera?) is an alternative initial choice for people who have detectable hepatitis B virus activity and ongoing liver inflammation. An advantage of adefovir compared to lamivudine is that resistance to adefovir is less likely to develop. In addition, adefovir can suppress lamivudine-resistant HBV. (See "Adefovir dipivoxil in the treatment of chronic hepatitis B virus infection".)Adefovir is taken by mouth, at a dosage of 10 mg/day, for at least one year. Most patients will need long-term treatment to maintain control of the hepatitis B virus. Adefovir is a weak antiviral medicine, and resistance does occur over time. Other medicines are available that are more potent.Entecavir — Entecavir (Baraclude?) is generally more potent than lamivudine and adefovir. Resistance to entecavir is uncommon in people who have never been treated with antivirals, but occurs in up to 50 percent of people who have used lamivudine. (See "Entecavir in the treatment of chronic hepatitis B virus infection".)Entecavir is taken by mouth, at a dosage of 0.5 mg daily for patients who have no prior treatment and 1.0 mg daily for patients who have resistance to lamivudine. Most patients will need long-term treatment to maintain control of the hepatitis B virus.Tenofovir — Tenofovir (Viread?) is more potent than adefovir. Resistance to tenofovir is rare. Tenofovir is taken by mouth, at a dosage of 300 mg daily. Tenofovir is effective in suppressing hepatitis B virus that is resistant to lamivudine, telbivudine, or entecavir. Tenofovir is not as effective in patients with adefovir-resistant hepatitis B. Resistance to tenofovir is uncommon. (See "Tenofovir disoproxil fumarate in the treatment of adults with chronic HBV infection who do not have HIV infection".)Telbivudine — Telbivudine (Tyzeka?) is more potent than lamivudine and adefovir. Resistance to telbivudine is common, and hepatitis B virus that is resistant to lamivudine is also resistant to telbivudine. Telbivudine is taken by mouth at a dosage of 600 mg daily. Other medicines are available that are less likely to cause resistance. (See "Telbivudine in the treatment of chronic hepatitis B virus infection".)Interferon-alpha — Interferon-alpha is an appropriate treatment for people with chronic hepatitis B infection who have detectable virus activity, ongoing liver inflammation, and no cirrhosis. Both conventional interferon and pegylated interferon are approved in the United States. (See "Standard and pegylated interferon for chronic hepatitis B virus infection".)Interferon-alpha may be considered in young patients who do not have advanced liver disease and do not wish to be on long-term treatment. Interferon-alpha is not appropriate for people with cirrhosis who have liver failure or for people who have a recurrence of hepatitis after liver transplantation.Interferon is given for a finite duration. Pegylated interferon, a long acting interferon taken once a week, is given for one year. This is in contrast to the other hepatitis treatments, which are given by mouth for many years until a desired response is achieved. Drug resistance to interferon has not been reported.The disadvantages of interferon-alpha are that it must be taken by injection and it can cause many side effects. Pegylated Interferon 2005, Lamivudine 1998, Adefovir Dipivoxil 2002, Entecavir 2005, Telbivudine2006, Tenofovir 2008 B Guidelines for Pregnant WomenWhat is hepatitis B? Hepatitis B is the most common serious liver infection in the world. It is caused by the hepatitis B virus (HBV) that attacks liver cells and can lead to cirrhosis (scarring) or cancer of the liver later in life. The virus is transmitted through contact with infected blood and bodily fluids.If I am pregnant, should I be tested for hepatitis B? Yes! Pregnant women who are infected with hepatitis B can transmit the virus to their newborns during pregnancy or delivery. Almost 90% of these babies will become chronically infected with hepatitis B at birth if there is no prevention.ALL pregnant women should be tested for hepatitis B to prevent infection.What if I test positive for hepatitis B while I am pregnant? Although most women do not have any pregnancy complications as a result of HBV infection she should be referred to a liver specialist for further evaluation. Although most women do not have any pregnancy complications as a result of HBV infection, it is still a good idea to be seen by a specialist.How can I protect my newborn from hepatitis B? If a pregnant woman tests positive for hepatitis B, her newborn child must be given the first dose of hepatitis B vaccine on Day 1, Day 30 and Day 60 with a booster at one year. If a baby does not receive these injections, then there is an up to 90% possibility that he or she will become chronically infected. However if on the rare occasions the vaccine does not work do not panic rigorous blood precautions by the mother can still protect the baby.How do I protect my child if another family member is infected with hepatitis B? Babies and children can be exposed to HBV from an infected dad, sibling, or other family member living in the same household. This can occur through contact with infected blood and bodily fluids. Vaccination is the best prevention against spreading the hepatitis B virus.Can I breastfeed my baby if I am infected with hepatitis B? According to the World Health Organization (WHO) it is safe for an infected woman to breastfeed her child. All women with hepatitis B are encouraged to breastfeed their babies since the benefits of breastfeeding outweigh the potential risk of transmitting the virus through breast milk. In addition, since all newborns should receive the hepatitis B vaccine at birth, the risk of transmission is reduced even further.How can I prevent getting hepatitis B if someone in my household is infected? We recommend that anyone living in a household with an infected family member should be vaccinated. This is especially important for babies and children since they are at greatest risk for developing a chronic infection if exposed to HBV at an early age. Until your 3 injection vaccine series is complete, it is important to avoid sharing any sharp instruments such as razors, toothbrushes, or earrings, etc. since small amounts of blood can be exchanged through these items. Also, infected individuals should be careful to keep all cuts properly covered. Blood spills should be cleaned with gloves and a 10% bleach/water solution. Hepatitis B is not transmitted casually and it cannot be spread through sneezing, coughing, hugging, or eating food prepared by someone who is infected with Hepatitis B.Remember that the best protection for you and your loved ones is the hepatitis B vaccine. Over 1 billion doses of the vaccine have been given, making it the most widely used vaccine in the world! ................
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