top of the pagedecision point
hepatitis b: should i take antiviral medicine for chronic hepatitis b?
you may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
hepatitis b: should i take antiviral medicine for chronic hepatitis b?
1get the | 2compare | 3your | 4your | 5quiz | 6your summary |
get the facts
your options
- take antiviral medicine for chronic hepatitis b.
- don't take antiviral medicine. have regular blood tests and maybe a liver biopsy to check for liver problems.
if you have used antiviral medicine once without success or have had a relapse after treatment, your choices are different, and this information does not apply to you. talk with your doctor to decide what is right for you.
key points to remember
- some people with chronic (long-term) hepatitis b don't develop serious problems and can live active, full lives without treatment. but others may develop severe liver damage. if this happens, you may need a liver transplant.
- treatment may not be an option for everyone who has hepatitis b, because antiviral medicines may not work for everyone.
- experts recommend antiviral medicines if you have high levels of both the hepatitis b virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
- some antiviral medicines that stop or slow the growth of the hepatitis b virus can have serious long-term side effects. and some can make you feel sick while you are taking them.
- you may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and a biopsy shows no signs of liver damage.
- people who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some antiviral medicines.
- you will probably need to take medicine for many years. and you'll need to have regular exams and blood tests to see if the virus is still active in your body and to find out how well your liver is working.
faqs
what is chronic hepatitis b?
you have chronic hepatitis b when the virus is active in your body for more than 6 months. the virus can damage liver cells and cause your liver to become swollen and tender.
most people who have chronic hepatitis b don't have symptoms. but they can still pass the infection to other people, especially the people they live with or have sex with, unless they receive treatment that gets rid of the virus.
most people with chronic hepatitis b don't develop serious problems. but about 15 to 25 people out of 100 who have the infection will die of cirrhosis or liver cancer.footnote 1 when there is a lot of the virus in your body, your chance of having these problems is greater. sometimes, chronic hepatitis b can lead to severe liver damage. if this happens, you may need a liver transplant.
what medicines are used to treat chronic hepatitis b?
there are several antiviral medicines that can be used to treat chronic hepatitis b. they are sorted into two groups:
- interferons, such as interferon alfa-2b and peginterferon alfa-2a. interferons are given as a shot 1 to 3 times a week for 4 to 12 months.
- nucleoside reverse transcriptase inhibitors (nrtis) such as adefovir, entecavir, lamivudine, telbivudine, and tenofovir. nrtis are taken as a pill once a day for at least a year, and usually for many years.
when you take interferons, you are less likely to relapse after you stop taking the medicine than if you took nrtis. but fewer people are helped by interferons than by nrtis.footnote 2
experts recommend antiviral medicines if you have high levels of both the hepatitis b virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
but antiviral medicines may not be right for everyone. the medicines can be helpful if you have or are likely to get liver damage, such as cirrhosis. but they may not help if you already have severe liver damage. people who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some of these medicines.
you may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and if your liver isn't damaged. your doctor may remove a tiny piece (biopsy) of your liver to see if it has been affected by the virus.
results from your blood tests can help you and your doctor decide which treatment might work best for you or if you need to take any medicine at all. some people with chronic hepatitis b can live active, full lives by taking good care of themselves and getting regular checkups to watch for liver problems. others may not need medicine right away, but will start taking antivirals later if tests show that the virus is active.
how well do antiviral medicines work?
antiviral medicines can stop or slow the growth of the hepatitis b virus and help prevent serious liver problems.
interferon stops the growth of the hepatitis b virus over the long term in about 35 out of 100 people.footnote 2 this means that it doesn't stop the virus in about 65 out of 100 people. recent studies suggest that peginterferon works a little better than interferon.footnote 3, footnote 4
nrtis slow the growth of the hepatitis b virus in your body. studies show that lamivudine and adefovir can reduce liver damage in about half of the people who take these medicines.footnote 5, footnote 6 entecavir can greatly reduce liver swelling and scarring. tenofovir is effective at reducing the amount of hepatitis b virus in the body.footnote 7 some studies show that entecavir works better than lamivudine or adefovir.footnote 8, footnote 9, footnote 10 tenofovir works better than adefovir against hepatitis b virus that is resistant to lamivudine.footnote 11
what are the side effects of antiviral medicines?
antiviral medicines can have serious side effects that may cause problems throughout your treatment. some people are not bothered by the side effects, while others stop taking their medicines because they feel too sick to finish them.
if you take interferons, you're more likely to have side effects than if you take nrtis.
side effects of interferons include:
- fever.
- headaches.
- hair loss.
- depression, which can be severe.
in rare cases, interferons can cause confusion and might affect your heart, thyroid, or kidneys.
side effects of nrtis may include:
- fever.
- sore throat.
- diarrhea.
- headaches.
- fatigue.
- weakness.
- dizziness.
- stomach or back pain.
in rare cases, nrtis have caused severe liver problems or a buildup of acid in the blood.
after any kind of treatment for hepatitis b, there is a chance that the virus will come back after you've stopped treatment.
the virus may also become resistant to the drug that you're taking. this means that the medicine no longer works to stop or slow the virus. if this happens, you may have to try another medicine. drug resistance is more likely with some nrtis.
why might your doctor recommend antiviral medicines?
your doctor might recommend antiviral medicines if:
- you have hepatitis b antigens in your blood.
- you have high levels of the virus in your blood.
- your liver enzymes are more than twice the normal amount.
- you have liver disease.
compare your options
compare
what is usually involved? | ||
|---|---|---|
what are the benefits? | ||
what are the risks and side effects? |
take antiviral medicinetake antiviral medicine
- you take shots or pills for months or for many years.
- you have regular exams and blood tests to check for liver problems.
- antiviral medicines can stop or slow the growth of the hepatitis b virus.
- they can help prevent serious liver problems.
- possible side effects include fever, headaches, diarrhea, hair loss, and depression.
- in rare cases, antiviral medicines may affect your heart, thyroid, kidneys, bones, or liver. or they may cause a buildup of acid in your blood.
don't take antiviral medicinedon't take antiviral medicine
- you have regular exams and blood tests to check for liver problems.
- you can take steps to prevent further liver damage by not drinking alcohol or using illegal drugs.
- you avoid the side effects of antiviral medicines.
- if the hepatitis b virus is active in your body, you may:
- get severe liver disease or liver cancer.
- spread the infection to others.
personal stories about using antiviral therapy for hepatitis b
these stories are based on information gathered from health professionals and consumers. they may be helpful as you make important health decisions.
my doctor says i have a good chance of doing well on interferon. my hbv dna test showed that i have a pretty low level of the virus in my body. and my blood tests showed that my liver enzymes are high. those factors mean i might do well on the medicine. and i guess women have better success than men, so that's another thing in my favour. i'm not wild about giving myself shots, but i'd rather do that than have major liver damage.
barbara, age 45
i found out a couple of years ago that i have hepatitis b. i thought about taking any medicine i could to help my liver. but so far, my tests show that my liver is in good shape. my liver enzyme levels are normal, even though i still have the virus in my body. it might not do me any good to take medicines yet. i'll have my liver checked regularly, and if things change, i'll reconsider.
phil, age 28
i've got diabetes as well as infection with hepatitis b virus. that means my immune system may not be as strong as it could be, so interferon may not help me much. but some people do really well on entecavir. i also like the fact that i can take it as a pill and do not have to have shots.
jamal, age 34
i just found out i'm infected with the hepatitis b virus. my symptoms weren't bad, just a little nausea. my liver enzymes are up a little, but so far there is no evidence i have any serious damage to my liver. it can take a while to develop that, and since i'm older, it could be years away. i think i'll just keep an eye on it and visit my doctor for checkups.
teresa, age 55
what matters most to you?
your personal feelings are just as important as the medical facts. think about what matters most to you in this decision, and show how you feel about the following statements.
where are you leaning now?
now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. show which way you are leaning right now.
what else do you need to make your decision?
check the facts
decide what's next
certainty
3. use the following space to list questions, concerns, and next steps.
your summary
here's a record of your answers. you can use it to talk with your doctor or loved ones about your decision.
your decision
next steps
which way you're leaning
how sure you are
your comments
your knowledge of the facts
key concepts that you understood
key concepts that may need review
getting ready to act
patient choices
credits and references
credits
| author | healthwise staff |
|---|---|
| clinical review board | clinical review board all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
references
citations
- american public health association (2015). hepatitis b. in dl heymann, ed., control of communicable diseases, 20th ed., pp. 257–264. washington, dc: american public health association.
- lok sfl, mcmahon bj (2009). chronic hepatitis b: update 2009. available online: http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/chronic_hep_b_update_2009%208_24_2009.pdf.
- janssen, h (2005). pegylated interferon alfa-2b alone or in combination with lamivudine for hbeag-positive chronic hepatitis b: a randomised trial. lancet, 365(9454): 123–129.
- lau gkk, et al. (2005). peginterferon alfa-2a, lamivudine, and the combination for hbeag-positive chronic hepatitis b. new england journal of medicine, 352(26): 2682–2695.
- hadziyannis sj, et al. (2003). adefovir dipivoxil for the treatment of hepatitis b e antigen-negative chronic hepatitis b. new england journal of medicine, 348(9): 800–807.
- marcellin p, et al. (2003). adefovir dipivoxil for the treatment of hepatitis b e antigen-positive chronic hepatitis b. new england journal of medicine, 389(9): 808–816
- reynaud l, et al. (2009). tenofovir and its potential in the treatment of hepatitis b virus. therapeutics and clinical risk management, 5(1): 177–185.
- chang t-t, et al. (2006). a comparison of entecavir and lamivudine for hbeag-positive chronic hepatitis b. new england journal of medicine, 354(10): 1001–1010.
- lai c-l, et al. (2006). entecavir versus lamivudine for patients with hbeag-negative chronic hepatitis b. new england journal of medicine, 354(10): 1011–1020.
- leung n, et al. (2009). early hepatitis b virus dna reduction in hepatitis b e antigen-positive patients with chronic hepatitis b: a randomized international study of entecavir versus adefovir. hepatology, 49(1): 72–79.
- hann h-w, et al. (2008). tenofovir (tdf) has stronger antiviral effect than adefovir (adv) against lamivudine (lam)-resistant hepatitis b virus (hbv). hepatology international, 2(2): 244–249.
you may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
hepatitis b: should i take antiviral medicine for chronic hepatitis b?
here's a record of your answers. you can use it to talk with your doctor or loved ones about your decision.
- get the facts
- compare your options
- what matters most to you?
- where are you leaning now?
- what else do you need to make your decision?
1. get the facts
your options
- take antiviral medicine for chronic hepatitis b.
- don't take antiviral medicine. have regular blood tests and maybe a liver biopsy to check for liver problems.
if you have used antiviral medicine once without success or have had a relapse after treatment, your choices are different, and this information does not apply to you. talk with your doctor to decide what is right for you.
key points to remember
- some people with chronic (long-term) hepatitis b don't develop serious problems and can live active, full lives without treatment. but others may develop severe liver damage. if this happens, you may need a liver transplant.
- treatment may not be an option for everyone who has hepatitis b, because antiviral medicines may not work for everyone.
- experts recommend antiviral medicines if you have high levels of both the hepatitis b virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
- some antiviral medicines that stop or slow the growth of the hepatitis b virus can have serious long-term side effects. and some can make you feel sick while you are taking them.
- you may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and a biopsy shows no signs of liver damage.
- people who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some antiviral medicines.
- you will probably need to take medicine for many years. and you'll need to have regular exams and blood tests to see if the virus is still active in your body and to find out how well your liver is working.
faqs
what is chronic hepatitis b?
you have chronic hepatitis b when the virus is active in your body for more than 6 months. the virus can damage liver cells and cause your liver to become swollen and tender.
most people who have chronic hepatitis b don't have symptoms. but they can still pass the infection to other people, especially the people they live with or have sex with, unless they receive treatment that gets rid of the virus.
most people with chronic hepatitis b don't develop serious problems. but about 15 to 25 people out of 100 who have the infection will die of cirrhosis or liver cancer.1 when there is a lot of the virus in your body, your chance of having these problems is greater. sometimes, chronic hepatitis b can lead to severe liver damage. if this happens, you may need a liver transplant.
what medicines are used to treat chronic hepatitis b?
there are several antiviral medicines that can be used to treat chronic hepatitis b. they are sorted into two groups:
- interferons, such as interferon alfa-2b and peginterferon alfa-2a. interferons are given as a shot 1 to 3 times a week for 4 to 12 months.
- nucleoside reverse transcriptase inhibitors (nrtis) such as adefovir, entecavir, lamivudine, telbivudine, and tenofovir. nrtis are taken as a pill once a day for at least a year, and usually for many years.
when you take interferons, you are less likely to relapse after you stop taking the medicine than if you took nrtis. but fewer people are helped by interferons than by nrtis.2
experts recommend antiviral medicines if you have high levels of both the hepatitis b virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
but antiviral medicines may not be right for everyone. the medicines can be helpful if you have or are likely to get liver damage, such as cirrhosis. but they may not help if you already have severe liver damage. people who have had an organ transplant or who drink too much alcohol or use illegal drugs may not be able to take some of these medicines.
you may not need to take antiviral medicines if you have normal or only slightly higher-than-normal levels of liver enzymes in your blood and if your liver isn't damaged. your doctor may remove a tiny piece (biopsy) of your liver to see if it has been affected by the virus.
results from your blood tests can help you and your doctor decide which treatment might work best for you or if you need to take any medicine at all. some people with chronic hepatitis b can live active, full lives by taking good care of themselves and getting regular checkups to watch for liver problems. others may not need medicine right away, but will start taking antivirals later if tests show that the virus is active.
how well do antiviral medicines work?
antiviral medicines can stop or slow the growth of the hepatitis b virus and help prevent serious liver problems.
interferon stops the growth of the hepatitis b virus over the long term in about 35 out of 100 people.2 this means that it doesn't stop the virus in about 65 out of 100 people. recent studies suggest that peginterferon works a little better than interferon.3, 4
nrtis slow the growth of the hepatitis b virus in your body. studies show that lamivudine and adefovir can reduce liver damage in about half of the people who take these medicines.5, 6 entecavir can greatly reduce liver swelling and scarring. tenofovir is effective at reducing the amount of hepatitis b virus in the body.7 some studies show that entecavir works better than lamivudine or adefovir.8, 9, 10 tenofovir works better than adefovir against hepatitis b virus that is resistant to lamivudine.11
what are the side effects of antiviral medicines?
antiviral medicines can have serious side effects that may cause problems throughout your treatment. some people are not bothered by the side effects, while others stop taking their medicines because they feel too sick to finish them.
if you take interferons, you're more likely to have side effects than if you take nrtis.
side effects of interferons include:
- fever.
- headaches.
- hair loss.
- depression, which can be severe.
in rare cases, interferons can cause confusion and might affect your heart, thyroid, or kidneys.
side effects of nrtis may include:
- fever.
- sore throat.
- diarrhea.
- headaches.
- fatigue.
- weakness.
- dizziness.
- stomach or back pain.
in rare cases, nrtis have caused severe liver problems or a buildup of acid in the blood.
after any kind of treatment for hepatitis b, there is a chance that the virus will come back after you've stopped treatment.
the virus may also become resistant to the drug that you're taking. this means that the medicine no longer works to stop or slow the virus. if this happens, you may have to try another medicine. drug resistance is more likely with some nrtis.
why might your doctor recommend antiviral medicines?
your doctor might recommend antiviral medicines if:
- you have hepatitis b antigens in your blood.
- you have high levels of the virus in your blood.
- your liver enzymes are more than twice the normal amount.
- you have liver disease.
2. compare your options
| take antiviral medicine | don't take antiviral medicine | |
|---|---|---|
| what is usually involved? |
|
|
| what are the benefits? |
|
|
| what are the risks and side effects? |
|
|
personal stories
personal stories about using antiviral therapy for hepatitis b
these stories are based on information gathered from health professionals and consumers. they may be helpful as you make important health decisions.
"my doctor says i have a good chance of doing well on interferon. my hbv dna test showed that i have a pretty low level of the virus in my body. and my blood tests showed that my liver enzymes are high. those factors mean i might do well on the medicine. and i guess women have better success than men, so that's another thing in my favour. i'm not wild about giving myself shots, but i'd rather do that than have major liver damage."
— barbara, age 45
"i found out a couple of years ago that i have hepatitis b. i thought about taking any medicine i could to help my liver. but so far, my tests show that my liver is in good shape. my liver enzyme levels are normal, even though i still have the virus in my body. it might not do me any good to take medicines yet. i'll have my liver checked regularly, and if things change, i'll reconsider."
— phil, age 28
"i've got diabetes as well as infection with hepatitis b virus. that means my immune system may not be as strong as it could be, so interferon may not help me much. but some people do really well on entecavir. i also like the fact that i can take it as a pill and do not have to have shots."
— jamal, age 34
"i just found out i'm infected with the hepatitis b virus. my symptoms weren't bad, just a little nausea. my liver enzymes are up a little, but so far there is no evidence i have any serious damage to my liver. it can take a while to develop that, and since i'm older, it could be years away. i think i'll just keep an eye on it and visit my doctor for checkups."
— teresa, age 55
3. what matters most to you?
your personal feelings are just as important as the medical facts. think about what matters most to you in this decision, and show how you feel about the following statements.
4. where are you leaning now?
now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. show which way you are leaning right now.
5. what else do you need to make your decision?
check the facts
1. if i have a lot of the hepatitis b virus in my blood and my liver enzymes are high, i may need to take medicines to treat the infection and prevent liver disease.
- true
- false
- i'm not sure
that's right. experts recommend antiviral medicines if you have high levels of both the hepatitis b virus and liver enzymes in your blood for at least 6 months or if you have liver disease.
2. there are medicines i can take to treat my infection, but i may have trouble taking some of them because of the side effects.
- true
- false
- i'm not sure
that's right. there are medicines that stop or slow the growth of the hepatitis b virus, but some of them can have serious side effects. some people stop taking their medicines because they feel too sick to finish them.
3. it's important that i get regular checkups to be sure the infection isn't getting worse and that the medicine is working.
- true
- false
- i'm not sure
that's right. you'll need to have regular exams and blood tests to see if the virus is still active in your body and to find out how well your liver is working.
decide what's next
1. do you understand the options available to you?
2. are you clear about which benefits and side effects matter most to you?
3. do you have enough support and advice from others to make a choice?
certainty
2. check what you need to do before you make this decision.
- i'm ready to take action.
- i want to discuss the options with others.
- i want to learn more about my options.
3. use the following space to list questions, concerns, and next steps.
credits
| by | healthwise staff |
|---|---|
| clinical review board | clinical review board all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
references
citations
- american public health association (2015). hepatitis b. in dl heymann, ed., control of communicable diseases, 20th ed., pp. 257–264. washington, dc: american public health association.
- lok sfl, mcmahon bj (2009). chronic hepatitis b: update 2009. available online: http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/chronic_hep_b_update_2009%208_24_2009.pdf.
- janssen, h (2005). pegylated interferon alfa-2b alone or in combination with lamivudine for hbeag-positive chronic hepatitis b: a randomised trial. lancet, 365(9454): 123–129.
- lau gkk, et al. (2005). peginterferon alfa-2a, lamivudine, and the combination for hbeag-positive chronic hepatitis b. new england journal of medicine, 352(26): 2682–2695.
- hadziyannis sj, et al. (2003). adefovir dipivoxil for the treatment of hepatitis b e antigen-negative chronic hepatitis b. new england journal of medicine, 348(9): 800–807.
- marcellin p, et al. (2003). adefovir dipivoxil for the treatment of hepatitis b e antigen-positive chronic hepatitis b. new england journal of medicine, 389(9): 808–816
- reynaud l, et al. (2009). tenofovir and its potential in the treatment of hepatitis b virus. therapeutics and clinical risk management, 5(1): 177–185.
- chang t-t, et al. (2006). a comparison of entecavir and lamivudine for hbeag-positive chronic hepatitis b. new england journal of medicine, 354(10): 1001–1010.
- lai c-l, et al. (2006). entecavir versus lamivudine for patients with hbeag-negative chronic hepatitis b. new england journal of medicine, 354(10): 1011–1020.
- leung n, et al. (2009). early hepatitis b virus dna reduction in hepatitis b e antigen-positive patients with chronic hepatitis b: a randomized international study of entecavir versus adefovir. hepatology, 49(1): 72–79.
- hann h-w, et al. (2008). tenofovir (tdf) has stronger antiviral effect than adefovir (adv) against lamivudine (lam)-resistant hepatitis b virus (hbv). hepatology international, 2(2): 244–249.
note: the "printer friendly" document will not contain all the information available in the online document some information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
current as of: june 12, 2023
author: healthwise staff
clinical review board
all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
