Hepatitis B

Although we would expect the number of hepatitis B carriers to decrease in time, largely due to widespread screening and immunisation efforts, there still exists a significant proportion of our population who are carriers. The treatment of these carriers include:

• Diagnosis and evaluation
• Supportive therapy
• Surveillance for liver cancer

I) Diagnosis and evaluation

Blood tests, ultrasonography of the liver and liver tissue sampling ( liver biopsy ) are used to assess the severity and stage of the illness. In suitable patients, appropriate treatment e.g. interferon may be instituted.

i) General Advice

• A carrier should avoid donating blood, blood products, organs and sperm.
• A carrier should inform his doctor, dentist or phlebotomist (health care worker who takes a patient's blood) of his hepatitis B status.
• Household contacts / sexual partners should be screened and immunised against hepatitis B if they are not immune.
• A carrier should not share his toothbrush / shaving equipment.
• A female carrier who delivers should have her child immunised at birth.
• Diet: Generally a normal nutritious diet should be recommended to healthy carriers. However, once a patient manifests signs of liver cirrhosis/failure, restriction in water and salt needs to be enforced.
• Exercise: A regular exercise programme is beneficial for asymptomatic carriers but patients with severe liver impairment should avoid strenuous jogging and heavy weight lifting.
• Drugs and Alcohol: drugs which may potentially damage the liver should be avoided if possible. Hepatitis B carriers should not take alcohol in excessive quantities. Care must be taken when self medicating. If in doubt, consult your doctor.

II) Supportive therapy

The aim of specific therapy is to reduce infectivity, stop the progression of the disease and ultimately prevent complications like cirrhosis ( 'liver failure with hardening' ) and cancer. These are basically 2 groups of drugs that are used by liver specialists, namely:

• Those that boost the immune system to eliminate the hepatitis B virus e.g. alpha- interferon ( see Hepatitis C treatment for more details on alpha-inteferon) and alpha-thymosin.
• Those that suppress viral replication ( anti-viral agents ) like famcyclovir or lamivudine.

Only alpha-interferon is registered, the rest are on trials at the Singapore General Hospital (SGH). Suitable hepatitis B carriers are treated with alpha-interferon. (To learn more about alpha-inteferon, see Hepatitis C treatment). Clinical trials using alpha-thymosin, famcyclovir, lamivudine are being conducted in SGH. The current success rate in the treatment of chronic hepatitis B is 30 - 40% using alpha-interferon. Interferon is costly, and has side effects.

III) Monitoring of hepatitis B carriers

Hepatitis B carriers should be followed up regularly at intervals depending on the stage of the disease. Besides monitoring the disease activity or progression, the patient is screened for liver cancer. The risk is estimated to be 200 times greater amongst hepatitis B carriers as compared to non-carriers. During such visits, besides a clinical examination, the patient is subjected to blood tests which includes an alpha-fetoprotein level. Alpha-fetoprotein is a tumour marker for liver cancer. Ultrasonography of the liver is usually performed at 6 - 12 monthly interval depending on the stage of the disease. These measures ensure that if a cancer is detected, the likelihood of it being early and curable is considerably higher.