Is Hepatitis B (HBV) vaccine used to treat existing Hepatitis B infection?

Hepatitis B Vaccination is Not Recommended for Individuals Already Infected with Hepatitis B Virus

Hepatitis B vaccination has no role in treating existing Hepatitis B virus (HBV) infections and is not recommended for individuals already infected with HBV. 1

Understanding Hepatitis B Infection and Treatment

Current Treatment Approaches for Chronic HBV Infection

• Treatment for chronic HBV infection focuses on suppressing viral replication and preventing disease progression through antiviral medications, not vaccines 1
• The primary therapeutic options for chronic HBV include:
  • Nucleos(t)ide analogues (NAs) for long-term viral suppression 1
  • Pegylated interferon (PegIFN) as an immunomodulatory approach 1
• Treatment decisions are based on viral load, ALT levels, and degree of liver fibrosis 2

Why Vaccination Doesn't Work for Existing Infections

• HBV vaccines contain only the hepatitis B surface antigen (HBsAg), which stimulates antibody production in uninfected individuals 1
• In already infected individuals, the virus has established persistent infection through:
  • Formation of covalently closed circular DNA (cccDNA) in hepatocytes 1
  • Integration of viral DNA into the host genome 1
• These viral reservoirs cannot be eliminated by vaccine-induced antibodies 3

Current Management Goals for HBV-Infected Individuals

Treatment Goals

• Persistent inhibition of viral replication 2
• ALT normalization 2
• Prevention of disease progression to cirrhosis and hepatocellular carcinoma 1
• Ideally, achieving HBsAg loss (functional cure) 1

Treatment Indications

• HBV DNA >2000 IU/mL with elevated ALT and/or moderate liver histological lesions 2
• All cirrhotic patients with detectable HBV DNA 2
• Patients requiring immunosuppression to prevent reactivation 2
• Pregnant women with high viral loads to prevent vertical transmission 2

Prevention of HBV Transmission from Infected Individuals

While vaccination doesn't treat existing infections, other preventive measures are important:

Recommendations for HBV-Infected Individuals

• Sexual contacts of infected individuals should be vaccinated 1
• Household members should be screened and vaccinated if susceptible 1
• Infected individuals should use barrier protection during sexual intercourse with non-immune partners 1
• Avoid sharing personal items like toothbrushes or razors 1
• Cover open cuts and clean blood spills with detergent or bleach 1

Special Considerations

• Pregnant women with HBV should ensure their newborns receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine immediately after delivery 1
• This combination is 95% effective in preventing perinatal transmission 1

Future Treatment Prospects

Current research is focused on developing more effective therapies for HBV infection:

• Novel direct-acting antivirals targeting various steps of the HBV lifecycle 1
• Immunotherapeutic agents to restore immune response to HBV 1
• Combination approaches targeting both viral replication and immune response 1
• Therapeutic vaccines (different from preventive vaccines) are under clinical evaluation 1

Common Pitfalls in HBV Management

• Mistaking HBV vaccination as a treatment for existing infection 1
• Failing to vaccinate close contacts of infected individuals 1
• Not recognizing the need for long-term monitoring of infected individuals 4
• Inadequate screening for complications like hepatocellular carcinoma 2

Conclusion

Hepatitis B vaccination is exclusively a preventive measure for individuals not already infected with HBV. For those with established infection, appropriate antiviral therapy based on clinical parameters is the standard of care, while vaccination should be reserved for their susceptible contacts to prevent transmission.