The search for new treatments for hepatitis B has been ongoing for decades. While effective at suppressing the virus, current treatments, which include antivirals, cannot eliminate it from the liver.
Hepatitis B (HBV) is a liver infection that results from the hepatitis B virus. People acquire it through contact with the bodily fluids of someone with the virus. The liver cleanses the body of waste, and the disruption to its processes can make a person seriously ill.
This article will outline the current treatment options for HBV. It will also discuss new treatments in development that may lead to a cure for HBV.
Initial infection with HBV is an acute infection. Most healthy people with infection with this virus will not have symptoms and can shed the virus easily. If tests show that a person still has the virus 6 months after contracting it, they have a chronic, long-term infection. Doctors use blood tests to diagnose and monitor the condition.
Treatment
Acute
There is little effective treatment apart from rest, following a nutritious diet, and maintaining hydration. If a person has severe symptoms, they may need treatment at the hospital.
Chronic
Medication is available to treat this condition, which has no cure and requires monitoring by a healthcare professional.
Treatment for chronic HBV
- Immune modulator drugs: These boost the immune system to help get rid of the hepatitis B virus. Healthcare professionals administer them as an injection for around 6 months to 1 year.
- Antiviral drugs: These slow down or prevent the virus from reproducing.
However, not everyone who has developed chronic HBV will require treatment. Following diagnostic tests, which include blood tests and scans, a healthcare professional will help a person decide when to start taking medication. Medication is usually most effective during active liver disease.
In addition to approved drugs, new, experimental drugs are also undergoing tests in clinical trials. Every drug goes through a rigorous testing process to evaluate its safety and effectiveness before receiving approval. If a person wishes to take part in a clinical trial, they can visit the National Library of Medicine.
Current treatment for HBV has been available for a long time, and healthcare teams understand their side effects well. These treatments include:
Nucleoside analogues (NAs) or oral antivirals
Antivirals, or NAs, slow down or stop the hepatitis B virus from reproducing, decreasing the risk of liver damage. Less liver damage occurs when there is less virus present.
People take NAs orally as a pill and experience very few side effects.
First-line treatments, such as Tenofovir disoproxil and entecavir, are potent and effective in suppressing the virus, but they only work for as long as a person takes them. Discontinuing treatment
Approved HBV drugs for adults include:
First-line treatments, including:
- tenofovir disoproxil (Viread)
- tenofovir alafenamide (Vemlidy)
- entecavir (Baraclude)
Second-line treatments, including:
- telbivudine (Tyzeka or Sebivo)
- adefovir dipivoxil (Hepsera)
- lamivudine (Epivir-HBV, Zeffix, or Heptodin)
Pegylated interferon (Pegasys)
Pegylated interferon is an immune modulator drug. Doctors give this drug by injection once a week for around 6 months to 1 year. Pegylated interferon can cause side effects such as flu-like symptoms and depression.
Interferon Alpha (Intron A)
Interferon is an immune modulator drug to help with HBV, but doctors do not use it as often as pegylated interferon. Healthcare professionals administer this as an injection several times a week for 6 months to 1 year or longer. Side effects include flu-like symptoms, depression, and headaches.
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A person can speak with a doctor about the best treatment option for them.
There are more than 30 new HBV drugs currently in development to cure this infection. A complete cure refers to the elimination of the virus from the liver. However, the Hepatitis B Foundation believes a more realistic goal would be a functional cure. The organization defines a cure as successful if it leads to a continued reduction in the virus and other disease markers in the blood. Additionally, this would still need to be the case even if an individual ceases treatment.
The new drugs fall into two categories: direct-acting drugs that target the virus and indirect-acting drugs that target the human host.
Direct-acting antivirals under development include:
- Small interfering RNA: These nucleotide drugs interfere with or destroy viral RNA.
- Tenofovir prodrugs: Get into liver cells and inhibit HBV.
- Entry inhibitors: Attach to a specific liver cell protein and interfere with HBV getting into cells.
- Capsid inhibitors: Prevent the capsid — the protein shield that covers and protects viral DNA — from forming.
- Smoothened agonist inhibitors: Prevent the production of HBV surface antigen, which the virus uses to enter and exit the liver cell.
- Covalently closed circular DNA (cccDNA) inhibitors: Target the small cccDNA molecule in the nucleus of the liver cell with the infection. The cccDNA molecule is the source of all HBV gene products. Developing these drugs remains very challenging but represents the most sought-after cure for this condition.
- Crispr-Cas and transcription activator-like effector nucleases: These are genome editing systems that health experts can use to attack and destroy cccDNA.
Indirect acting antivirals under development include:
- Therapeutic vaccines: Use vaccine technology to stimulate immunity, as people with HBV do not have an effective immune response to the virus.
- Toll-like agonists: Activate the body’s innate immune system and prompt cells to defend themselves against HBV infection.
- Stimulator of interferon genes (STING): In this approach, a small molecule STING eliminates all detectable HBV gene products.
- Second mitochondrial-derived activator of caspases mimetics: This new class of drug induces the death of certain cells. These drugs might be able to induce the death of liver cells with an HBV infection.
- Cyclophilin inhibitors: Cyclophilins have involvement in liver diseases, such as HBV, by helping the virus enter the liver cell. Therefore, inhibiting cyclophilins might prove beneficial in treating HBV.
Combination therapy
Most experts think a combination of two or more drugs will prove the most beneficial in treating chronic HBV.
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Although some studies have shown promising results, there is no reliable evidence that combination therapy is better than one therapy on its own. Larger studies are necessary to investigate the safety and efficacy of this type of treatment.
Many people with HBV do not know they have the virus. If a person thinks they have had exposure to the bodily fluids of someone with HBV, they should seek immediate medical treatment.
Getting a vaccine within 24 hours of contracting the virus can stop an infection from developing.
A person with acute HBV can feel well, and the infection can go away on its own. If HBV lasts for 6 months or longer, a person has developed chronic HBV. They may need treatment depending on how much virus is present in their liver.
Chronic HBV can lead to serious complications such as liver cancer and cirrhosis.
Learn more about the side effects of the hepatitis B vaccine.
While there is no cure for HBV, many available treatments can help prevent liver damage.
Approved medications to treat HBV include oral antiviral drugs and immune modulator drugs. These two treatment approaches offer different benefits and drawbacks. A person should speak with a doctor about the right treatment for them.
Additionally, individuals can apply to join a clinical trial to test new drugs if standard treatment is ineffective.
More than 30 new drugs are in development, and there is optimism that at least one of them will provide a functional cure for HBV. A combination of drugs might prove beneficial in treating HBV.