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Viral Hepatitis and Liver Disease

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Should all patients with chronic hepatitis B be on treatment?

for Veterans and the Public

Should all patients with chronic hepatitis B be on treatment? - Hepatitis B for Patients

No, not all patients with hepatitis B need to be on treatment. Choosing the right time for hepatitis B treatment is not a simple decision. It is based on the results of blood tests, the patient's age, and the degree of scarring in the liver. A liver biopsy may be required.

What determines whether a patient with chronic hepatitis B needs treatment?

Hepatitis B drugs are recommended for patients with very active virus and an inflamed liver. These patients will have a very high amount of hepatitis B virus in their blood (sometimes referred to as the hepatitis B viral load) and an unusually high level of a chemical known as ALT, which is one of the "liver enzymes" that helps the liver do its work. People with cirrhosis also may be candidates for treatment.

Over time, patients can go through different phases with their hepatitis B. A patient can have a low amount of virus and normal level of ALT for many years, prolonged periods of high viral loads and ALT levels, or short bursts of high viral activity that later subside. It is important to use hepatitis B treatments during phases of high viral activity and prolonged liver inflammation. Doctors will track the phase of a person's hepatitis B by the results of blood tests. Because infected people go through the various phases of hepatitis B, it is recommended that they have blood tests on a regular basis.

For the small percentage of patients who have chronic hepatitis B and also have chronic hepatitis C, when it comes time to be treated with medication for the hepatitis C virus, the hepatitis C medications can cause the hepatitis B virus to flare. In order to prevent this from happening, these patients will need to take hepatitis B treatment (with different medications) at the same time that they take the hepatitis C virus medications.