Hepatitis B – Treatment at Sheba Medical Center in Israel
Hepatitis B is a chronic inflammatory infectious liver disease caused by the hepatitis B virus (HBV). It is a significant health problem around the world, responsible for more than one million deaths every year. While a vaccine is available for hepatitis B, it is essential for infected people to take precautions to help prevent spreading the virus.
In most cases, adults with hepatitis B make a full recovery, even if they suffer severe symptoms. However, sometimes this serious liver infection becomes chronic, which significantly raises the risk of it progressing to cirrhosis, primary liver cancer (hepatocellular carcinoma), and liver failure. At Sheba Medical Center, The Center for Liver Diseases features specialized inpatient and outpatient clinics to treat patients with chronic hepatitis B infection. Multidisciplinary specialists apply the latest antiviral drugs when designing customized treatments.
What are the risk factors for hepatitis B?
The most common way to contract a hepatitis B infection is by contact with body fluids that are infected with HBV, such as blood, saliva, semen or vaginal secretions.
The primary risk factors for contracting hepatitis B include:
- Having unprotected sex, heterosexual or homosexual, with multiple partners or with a person infected with HBV
- Sharing needles during IV drug use
- Receiving a blood transfusion before the early 1970s
- Living with someone who has chronic HBV
- Being born to a mother infected with HBV
- Working at a job that exposes you to human blood, such as in a health care facility
- Traveling to areas with high rates of HBV infection, such as Africa, Asia, the Pacific Islands, and Eastern Europe
What are the types of hepatitis B?
HBV infection can be either chronic (long-lasting) or acute (short-term).
- Acute hepatitis B: this type of the disease is more common among adults and lasts less than six months. In general, the immune system can eradicate HBV from the body, and a complete recovery should occur within a few months in 95% of infected persons. However, sometimes it can lead to chronic infection. In particular, the younger you are when you get HBV (such as younger than five years old), the higher the chances of developing chronic HBV.
- Chronic hepatitis B: this type of the disease is common in Southeast Asia and Africa, however it can be detected globally. It lingers in the body because the immune system cannot fight off the infection. Chronic HBV can last a lifetime and possibly lead to other severe liver illnesses – a quarter of patients develop cirrhosis within 20 years, and a small percentage develop primary liver cancer (hepatocellular carcinoma).
What are the symptoms of acute hepatitis B?
Usually, it takes about 45 days for the symptoms of hepatitis B to appear after you have been infected. Some individuals may not present with any symptoms.
The most common symptoms of HBV, which can range from mild to serious, include:
- Abdominal pain
- Dark colored urine
- Joint pain
- Appetite loss
- Nausea and vomiting
- Weakness and fatigue
- Skin rashes and/or itching all over your body
- Jaundice (yellowing of your skin and the whites of your eyes)
- Pain over your liver area
What are the symptoms of chronic hepatitis B?
Most infected patients are asymptomatic and randomly diagnosed.
When the disease progresses, patients develop the hepatic expression of cirrhosis and its complications:
- Weakness and fatigue
- Upper GI bleeding
- Hepatic encephalopathy
- Hepatocellular carcinoma (primary liver cancer)
What treatments does Sheba offer for hepatitis B?
If you are diagnosed with acute hepatitis B, it is possible that no medical treatment is needed. Sheba’s doctors will evaluate your condition thoroughly to recommend the best therapeutic options. Rest, drinking plenty of fluids and electrolytes, and proper nutrition may be enough to help your body fight the hepatitis B infection. In more severe cases, we may advise you to stay in the hospital and/or take antiviral drugs to prevent complications.
If you are diagnosed with chronic hepatitis B infection, you might require lifelong antiviral treatment and monitoring. At our Center for Liver Diseases, we consult regarding the need for antivirals, we customize the treatment individually and provide several critical procedures for patients with cirrhosis and its complications, including draining of ascitic fluid, administering intravenous medications and placing a transjugular intrahepatic portosystemic shunt (TIPS) for selected patients. We also provide consultation regarding the available options to treat hepatic encephalopathy and upper GI bleeding. We also evaluate and advise patients who require liver transplantation due to hepatitis B.
The therapies that we offer at Sheba aim to: suppress the virus, reduce inflammation, decrease your risk of developing hepatocellular carcinoma (primary liver cancer), slow the progression to liver failure and cirrhosis, and prevent you from spreading the disease.
Antiviral medications – specialized treatment
At Sheba, we offer the most advanced, custom-tailored antiviral medications available. These oral drugs can help fight HBV by suppressing replication of the virus and diminishing its potential to cause liver damage. At present, there are three major antiviral drugs that are considered highly effective; typically, they are taken daily.
Before the administration of antiviral drugs at Sheba, our specialists will perform testing to obtain essential information about the degree of inflammation and scarring in the liver. This information provides data to help formulate personalized antiviral therapies for each patient.
These diagnostic tests include:
- An ultrasound-guided liver biopsy
- A fibroscan/FibroTest, which are non-invasive tests to evaluate the severity of liver disease
- Elastography, an imaging technique that measures the elasticity of hepatic (liver) tissue. It can be used in conjunction with ultrasound
- Viral laboratory tests to detect resistance to ongoing antiviral drug treatment
Your body naturally produces interferon to fight infection, and interferon injections involve taking a synthetic version of this substance. This treatment is used primarily for young people with HBV who want to avoid long-term therapy or women who plan to conceive within a few years of receiving treatment. (Interferon is not approved during pregnancy.)
Meet the Doctors
Ziv Ben Ari, MD
Ziv Ben Ari, MD
Director of the Center for Liver Diseases and of the Liver Research Laboratory
Prof. Ben Ari is an internationally renowned leader in the field of hepatology. She received advanced liver transplant and hepatology training at the Royal Free Hospital in London, and she is the current chair of the Israeli Association for the Study of the Liver. She is also a member of the Faculty of Medicine at Tel Aviv University. Prof. Ben Ari has received numerous grants for her ongoing liver research; she has published more than 170 articles.
Yana Davidov-Darbianik, MD
Senior Physician at the Center for Liver Diseases
Dr. Davidov is a specialist in internal medicine, with a focus on the treatment of various liver diseases, including hepatitis B and C, fatty liver, viral liver diseases, autoimmune and cholestatic liver disease (PBC, PSC), and cirrhosis. She studied medicine at the National University, School of Fundamental Medicine, Kharkov, Ukraine.
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