What is the treatment for a Hepatitis B (Hep B) test showing active infection when positive?

From the Guidelines

Treatment for active Hepatitis B infection typically involves antiviral medications such as entecavir (0.5-1mg daily) or tenofovir (300mg daily), which are taken orally as long-term therapy, often for years or even lifelong in chronic cases. These medications suppress viral replication, reducing liver inflammation and preventing progression to cirrhosis or liver cancer 1. For acute infections, treatment may be supportive care only, as many adults clear the virus naturally within 6 months. However, chronic infection (lasting more than 6 months) requires medical intervention. The primary goal of treatment is to eliminate or significantly suppress replication of HBV, thereby preventing progression of liver disease to cirrhosis, liver failure, or hepatocellular carcinoma 1.

Some key points to consider in the treatment of active Hepatitis B infection include:

• Regular monitoring through blood tests every 3-6 months is essential to track viral load, liver function, and treatment response 1.
• Patients should avoid alcohol, maintain a healthy diet, and get vaccinated against Hepatitis A to prevent additional liver damage.
• It's important to understand that while treatment can control the virus, complete cure is uncommon, making long-term management necessary.
• Patients should inform sexual partners and household contacts who should be tested and vaccinated if not immune to prevent transmission.
• The choice of antiviral drug depends on several factors, including patient characteristics, HBV DNA and serum aminotransferase levels, and HBeAg status 1.
• Surrogate end points of antiviral treatment include loss of HBeAg and HBsAg, HBeAg seroconversion in HBeAg-positive patients, and suppression of HBV DNA to undetectable levels by polymerase chain reaction in patients who are HBeAg-negative 1.

In terms of specific treatment regimens, entecavir and tenofovir are both highly potent antiviral agents, with rates of virologic remission of >90% in treatment-adherent patients after 3 years 1. These medications are administered orally and have a favorable safety profile over the course of several years. Peginterferon alfa-2a is also a preferred first-line treatment, but it is administered via subcutaneous injection and can be difficult to tolerate 1.

From the FDA Drug Label

Entecavir tablets are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease The treatment for a Hepatitis B (Hep B) test showing active infection when positive is entecavir tablets, which are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication.

• The recommended dose of entecavir tablets for chronic hepatitis B virus infection in nucleoside-inhibitor-treatment-naïve adults is 0.5 mg once daily.
• The recommended dose of entecavir tablets in adults with a history of hepatitis B viremia while receiving lamivudine or known lamivudine or telbivudine resistance substitutions is 1 mg once daily.
• The recommended dose of entecavir tablets for chronic hepatitis B virus infection in adults with decompensated liver disease is 1 mg once daily 2 2.

From the Research

Treatment for Hepatitis B (Hep B) Test Showing Active Infection

The treatment for a Hepatitis B (Hep B) test showing active infection when positive involves antiviral therapy to prevent cirrhosis and hepatocellular carcinoma.

• The goal of antiviral therapy is to suppress HBV replication persistently 3.
• Seven drugs are available for the treatment of chronic hepatitis B, including IFN-alpha, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 3.
• The choice of drug should consider the clinical features of patients, antiviral efficacy, risk of resistance, long-term safety profile, method of administration, and cost of therapy 3.

Ideal Candidates for Treatment

Ideal candidates for treatment are:

• Hepatitis B e antigen-positive patients with a prolonged phase of immune clearance 3.
• Hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase, and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 3.
• Patients with compensated or decompensated cirrhosis should be treated, even if alanine aminotransferase levels are normal and/or serum HBV DNA levels are low 3.

Effective Antiviral Agents

• Tenofovir and entecavir are the most effective antiviral agents for chronic hepatitis B 4.
• Entecavir is a valuable agent for the first-line treatment of chronic hepatitis B in patients with decompensated liver disease 5.
• Lamivudine plus adefovir combination therapy is more effective than entecavir monotherapy for lamivudine-resistant chronic hepatitis B 6.

Treatment Options

• Entecavir therapy provides a valuable first-line option in nucleoside-naive patients with chronic HBV infection and is a useful alternative in lamivudine-refractory patients 7.
• Oral entecavir is approved for the treatment of chronic HBV infection in adults with evidence of active viral replication and persistently elevated serum ALT and/or AST levels, and/or histological evidence of active disease 7.