The betterment of the timbre of life and the survival of patients infected with the disease have been established as a fundamental objective ; this means avoiding progression to cirrhosis and/or hepatocellular carcinoma or , in the case that cirrhosis of the liver is already ground , preventing the appearance of decompensation , advanced liver failure or destruction . This objective can be achieved if the suppression of viral retort and the decrease in DNA level are achieve until they are undetectable with the current substantial - time PCR elaboration techniques ( catching limit of 10 - 200 IU / ml count on the proficiency used ) .
The suspension of viral reverberation is tie in with other additional objectives , such as the biochemical reception ( normalisation of transaminases ) , the serological reply ( expiration of HBeAg and seroconversion in convinced HBeAg affected role ) and histologic melioration ( decreased necroinflammatory action ) .
Can A Person Be Cured of Hepatitis B?
Before any affected role name with inveterate hepatitis HBV , the pauperization or not to institute an antiviral discussion must be considered , which requires an tolerable rating of the patient .
In all cases , a complete serology of HBV is necessary with markers of replication and quantification of viral load , as well as a screening for hepatocarcinoma and the exclusion of other viral contagion associated with HBV , such as HCV , HDV and HIV .
The general indication for treatment are established mainly base on three variable star : the level of viral replication of HBV ( DNA quantification ) , the horizontal surface of alteration of aminopherase ( ALT ) and the histological damage honor in the liver biopsy . The main clinical exercise guideline propose to originate the handling in those patients who show an active viral replication along with inflammation or meaning hepatic fibrosis .
There Are Certain subgroup Of universe Where Antiviral Treatment Is Not Indicated :
In those patients who are in the resistant - tolerance phase ; they are characterise by in high spirits levels of viral desoxyribonucleic acid and normal transaminases .
In all likelihood , the liver biopsy would not show important histological damage in these cases , which is why it is not indicated . These are young patients , under 30 years of geezerhood , who will require further keep abreast - up .
There is also no indication of treatment in patients with occult hepatitis B ( HBsAg negative with detectable DNA ) or in inactive HBV carrier who have low levels of viral DNA ( less than 2000 IU / ml ) and normal transaminase . It is important to distinguish the inactive carriers from the negative HBeAg patients , in whom there may also be low-spirited DNA levels and prolonged period without alteration of transaminase , requiring a farsighted - terminus follow - up with periodical determination of DNA and ALT to be able to characterize them and process them if they meet the appropriate standard .
In patient with continuing hepatitis HBV in whom adherence to treatment or clinical follow - up is doubtful or erratic , the antiviral discussion should not be initiated due to the lack of answer to it , the risk of infection of resistances and the economic cost .
Available Drugs and Treatment Strategies
Once the indication to initiate an antiviral intervention is establish , different ingredient must be assessed to choose the drug to be used , as well as the most passable sanative scheme . It is necessary to individualize these decision with each affected role , taking into chronicle various factors such as age , link comorbidities or the possibility of a future maternity . The patient should be instructed of the advantages and possible disadvantages of each drug and make them part of the treatment of their disease , since in most case it will be a prolong handling , often undefined , with the consequent danger of resistance and/or side effect , expect adherence and participation by the affected role .
There are currently 7 approved drugs for the treatment of HBV : interferon ( received and its pegylated form ) whose use imply a scheme intervention limited to 48 week ; and nucleoside analog that include 3TC , adefovir , telbivudine , entecavir and tenofovir , and which ordinarily involve keep up , if not indefinite , discourse .
Conclusion
In the case of Hepatitis B virus , the disappearing of HBsAg and seroconversion to anti - HBs would be the ideal object lens . Unfortunately , this end is achieved in a modest proportion of patients with current treatment due to the virological characteristics of Hepatitis B virus .
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