What is a viral hepatitis? What are the symptoms of viral hepatitis? How is viral hepatitis transmitted? Who is at risk of a fatal hepatitis infection? What about hepatitis B and pregnancy What about hepatitis B and the newborn? How does HIV/AIDS infection interact with hepatitis B and hepatitis C? How is hepatitis diagnosed? Is there a treatment for viral hepatitis? Is a special diet required? How can I prevent the transmission of my viral hepatitis? How can I prevent contracting viral hepatitis? Who is eligible for free vaccination against hepatitis B (HBV)? Who should consider hepatitis A vaccination? Links and References

Hepatitis A and E will resolve spontaneously without treatment. Supportive measures may be prescribed to help relieve your symptoms while your body and immune system gets rid of the virus. After a known exposure to the hepatitis A virus, administration of a shot of Immune Globulin within 14 days of exposure should be considered. If administered within a couple of weeks of the exposure, it will usually be effective in preventing or at least ameliorating the disease. Consult your physician!

The future looks bright for individuals living with chronic hepatitis B. Only a decade ago there were no treatment options. Although there is still no complete cure for hepatitis B, there are 6 approved drugs for adults (2 for children) and many promising new drugs in development. Current treatments seem to be most effective in those who show signs of active liver disease.

Not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy or a clinical trial. Be sure that you understand the pros and cons of each treatment option.

Whether you decide to start treatment or not, it is very important to be seen by a liver specialist or doctor knowledgeable about hepatitis B on a regular basis.

The field of hepatitis B treatment is rapidly evolving. There are several agents currently able to suppress HBV that are licensed in Canada, as follows:

• 3TC (lamivudine, Heptovir)
• adefovir (Hepsera)
• entecavir (Baraclude)
• emtricitabine (FTC, Emtriva)
• interferon-alpha (Pegasys or Pegetron)
• tenofovir (Viread)
• tenofovir and FTC in one pill (Truvada)

Many of these medications (except for entecavir, adefovir and interferon-alpha) also have significant anti-HIV activity and are used for treating this infection. This will be critical if you are co-infected with both HBV and HIV (speak with your physician).

From research to approval, drugs undergo rigorous scrutiny by Health Canada authorities. Once a new medication has been approved by federal regulatory authorities in Canada, it undergoes another review process that helps provinces and territories decided if it will be placed on their list of subsidized medicines. So, the availability of these drugs varies from region to region. Your physician and pharmacist can keep you up to date.

Combination therapy?

Until recently, few anti-HBV agents were available, so therapy generally consisted of using the one available drug at a time (monotherapy) with 3TC. But 3TC's benefits against HBV may not last over the long term, when used alone, as HBV gradually builds up resistance (the capacity to circumvent the medication). With the development and availability of newer drugs, the issue of whether or not to treat HBV with combination therapy arises (similar to the history when HIV treatments were first investigated).

The hope with combination HBV therapy is that it will delay the development of drug resistance. But until more studies are done, the best choice of available agents is not clear. Further research is necessary to improve tolerance and treatment outcomes.

Although these drugs for chronic hepatitis B are approved, they do not provide a complete cure, except in rare cases (a "cure" generally means that a person loses the hepatitis B virus and develops protective surface antibodies).

The drugs, however, significantly decrease the risk of liver damage from the hepatitis B virus by slowing down or stopping the virus from reproducing. As with HIV, it appears that combination therapy will probably be the most effective method of combating chronic hepatitis B infections.

When addressing the issue of the treatment of hepatitis C infection, a combination of two antiviral medications (interferon and ribavirin) prescribed over a period of 6 to 12 months appears to be quite effective. The actual treatment duration is determined based on the type of hepatitis C present (genotype), the degree of liver involvement and the initial response to therapy. Current treatment regimens can provide a cure in at least 50 % of patients.

Your physician will assist you in determining the treatment approach best suited to you.