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For further information and appointments please see the below contact numbers:

For Mr Rob Hutchins: 

020 7234 2940

For the following Consultants: 

020 7234 2730

Professor Nigel Heaton
Professor Mohamed Rela
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Kosh Agarwal and 
Dr Michael Heneghan

 

Treatment for Liver Disease, London

Hepatitis B

Hepatitis B is a viral infection which affects the liver. The infection is carried in your blood and its symptoms can be short lived (acute) or continue for a long time which is known as chronic.   The virus is carried in blood, so it can be spread by contact with infected blood as well as body fluids. Hepatitis B virus is also simply called HBV.

Hepatitis B is diagnosed by testing your blood to see if you have antibodies to the infection. If you have these antibodies, it means that you are infected with hepatitis B as the body produces them to try and fight the infection.

How do you catch Hepatitis B?

Hepatitis B is passed on when blood or body fluids (saliva, semen and vaginal secretions) from somebody who has hepatitis B infects someone who has not previously been exposed to the virus. You cannot catch it from normal day to day social contact such as shaking or holding hands, cuddling or sharing plates and cutlery.

Common ways in which to pick up Hepatitis B include:

  •  Mother to baby

If you have hepatitis B your baby may become infected at birth when the baby comes into contact with your infected blood and other body fluids, which is why all pregnant women should be tested for   HBV. If you are infected, it may be that your baby will need an injection of an antibody known as immunoglobulin together with a series of HBV vaccinations to help neutralise the virus.

  • Blood to blood contact
  • By receiving a blood transfusion overseas where donors are not screened for the hepatitis B
  • Through infected blood products in the UK before the mid 1970s
  • By sharing needles, syringes or injecting equipment to inject drugs
  • By snorting/inhaling drugs with a shared straw/tube/banknote which is contaminated with HBV infected blood
  • By having tattoos or body piercings if the shared equipment is not sterilised properly
  • By being injured by an infected needle
  • By sharing contaminated personal grooming items such as razors, toothbrushes, hair clippers or nail scissors and manicure/pedicure equipment
  • Sexual activity  (by having unprotected oral, vaginal or anal sex with an infected person)

What are the symptoms of Hepatitis B?

Many people do not have symptoms when they are first infected. However, in the beginning at the acute stage, you may have symptoms that include feeling generally unwell with a flu-like illness, nausea, vomiting and abdominal pain this can last for a number of weeks. 

You can also develop jaundice where your skin and the whites of your eyes become yellow, your urine becomes dark, your stools become pale and you may experience itchy skin (pruritis). It may take a few months to feel fit and well again. Around 90 to 95% of adults with HBV will get better naturally and will not have any lasting health problems.

The 5 to 10% of adults who do not naturally lose the virus may develop chronic or long term HBV which generally means the infection has continued for longer than six months. If you have chronic HBV you may be a carrier but have no symptoms of the infection yourself and you may not even know that you have been infected. However you can still unknowingly pass the virus onto somebody who is not immune. It is also possible to have symptoms similar to those in the acute stage that may come and go.

If you have chronic HBV the infection will cause liver inflammation but in most people this will not result in any further problems. However, 15 to 40% of people with chronic HBV are more likely than those without the infection, to develop irreversible scarring of the liver which is known as cirrhosis. 

In addition, over time the virus may encourage liver tumours to develop. These tumours are known as hepatocellular carcinoma or HCC A very small proportion of people - 0.01% to 1.2% - may develop liver cancer regardless of how much liver damage they have.

How chronic Hepatitus B affects the liver

The cells in the liver (hepatocytes) may become inflamed and cause scar tissue (fibrosis) which is stiffer than normal tissue. The amount of scarring in your liver may progress from mild to moderate and then to severe. Over time, the healthy liver cells may be replaced with increasing amounts of scar tissue as your liver becomes cirrhotic, loses its shape and starts working less efficiently. When cirrhosis is severe the damage causes your liver to gradually stop working and this is known as liver failure. The only treatment for liver failure is a liver transplant.

 Certain factors influence how quickly your liver will develop cirrhosis. These include:

  • continued drug abuse
  • eating a diet high in saturated fats
  • having another viral infection such as HIV, hepatitis C or D
  • having high numbers of hepatitis B circulating in your blood. This is known as having a high viral load   
  • having other conditions such as diabetes or high cholesterol
  • regularly drinking large quantities of alcohol.   Male – 21 units and over per week. Female: 14 units and over per week

Co-infection

Around 8 – 10% of people diagnosed with either acute or chronic hepatitis B are also infected with hepatitis D (which is also called Delta virus or HDV) and this is known as co-infection. HDV is a parasitic virus which attaches itself to the outer surface of the hepatitis B virus to survive and reproduce. Hepatitis D is spread via blood to blood contact and can be passed from person to person in a similar way to hepatitis B.
 
If you are a long term i.e. chronic carrier of HBV then there is also a risk of HDV which is known as a super infection and can be very aggressive with between 60 – 70% of those people carrying both viruses developing severe liver damage within five to ten years.
 
At the London Liver Centre, our specialist hepatologists will test, advise and prescribe for all hepatitis viruses and advise on the best way to manage your disease. You will need to be followed up regularly with blood tests and ultrasound scan so that we can check for any signs of progression of disease.  
 

Commonly used hepatitis markers:

 

HBV surface antigen
HBsAG +ve
Presence of HBV virus
HBV surface antibodies
HBsAB +ve
Recovery from the virus – antibodies demonstrate an immune system response
Viral load (HBV DNA level)
 
It shows the number of viral particles in the blood. Levels can fluctuate but generally the higher the number, the higher is the risk of liver injury/disease progression and liver cancer. This can be controlled by monitoring and treatment
E antigen positive
HBeAg+ve
Active replicating form of the disease
E antigen negative
HBeAg – ve
This is often used in conjunction with the result of your viral load to determine if the disease is active or inactive. If your viral loads are persistently below 1000 IU/ml with normal liver function tests this indicates that you are a carrier state and need “watchful monitoring” rather than treatment.
If your viral load is persistently high (10,000 – 100,000 IU/ml) then you may need treatment
This test can also indicate that your immune system has spontaneously (i.e. naturally) cleared the virus. It may also signify seroconversion (i.e. from eAg+ve to eAg-ve) following antiviral treatment.
 

What is antiviral treatment for Hepatitus B?

Not everybody requires treatment and whether you do is to be discussed and determined by our hepatologist and it may take several visits to determine whether or not treatment is necessary. Treatment may be monotherapy (i.e. one medicine) or combination therapy which is two or more medicines. Our hepatologist will discuss this with you and decide which would suit you better.

About 1% of people with chronic HBV will spontaneously get rid of the virus (i.e. quite naturally) however, for the majority of people who have been diagnosed with active disease, the virus is controllable rather than curable. The aim of treatment is to improve and maintain the quality of life by using antiviral medicines which can completely suppress the replication of the virus. The aim of viral suppression is to prevent the progression of fibrosis (scar tissue) liver failure and the development of cancer.

Treatment for Hepatitus B in London:

If you are diagnosed as E antigen positive (HBeAg+ve) you may be offered treatment with Pegylated Inferon. This is a synthetic form of Interferon which is naturally produced by your body in response to a virus. This treatment is given weekly by under the skin (subcutaneous) injection.  

Pegylated Interferon is thought to be successful in a ratio of between 30 – 40% in converting active HBV to seroconversion (carrier state). This means that there will be no further injury to the liver . But the chance of it clearing the virus is thought to be less than 5%.

Currently this is the only treatment for HDV. Interferon has a 20 – 30% success rate in suppressing the delta virus and if the virus is not detected after six months of completion of the Pegylated Interferon therapy, it is thought that it will remain suppressed.

 If your infection is E antigen negative (HBeAg-ve) or if the therapy is not successful, then you may be offered medication known as nucleosides and nucleotide with the aim of using this medication to suppress virus replication.   This is a long term medication which might well need to be taken for life.

            
Oral antiviral tablets
Tenofovir
Entecavir
Lamivudine
Adefovir
Lamivudine together with Adefovir
Truvada (Tenofovir and Emtricitabine)
 

Pegylated Inferon is not a quick treatment and may take some considerable time. It can also cause side effects including fever, headaches, fatigue, muscle aches, difficulty sleeping, low mood, being more likely to catch other infections, thyroid gland, blood sugar and skin problems.    It will also be important to attend regular check ups in order that your therapy can be monitored and you can be helped with any side effects.

Vaccination from Hepatitis B in London

Vaccination against hepatitis B is an important preventative measure. It consists of three injections over a period of six months. There is also an accelerated course of the vaccine which is given over three months and requires a fourth dose at twelve months. This is more suitable for certain vulnerable or high-risk groups.

About 90% of people vaccinated respond by becoming immune to infection by developing hepatitis B surface antibodies, so that about 10% of people do not respond. There are two types of hepatitis B vaccine available, so it may be that if one is unsuccessful, the other could be tried.

If you have already been exposed to the virus, a vaccination will not stop you from becoming infected.

If you have been diagnosed with having active HBV or as an HBV carrier, your partner/spouse and children and children living in the same household as you or your house mates may need to be screened for, and vaccinated against, the virus. You will be advised regarding this. Hepatitis B injections can be given at your GP surgery, travel clinics, sexual health clinics and drug centres.

 Other precautions against Hepatitus B:

  • dispose of dressings in two bags, one inside the other (carrier bags are alright to use) – to make sure that no one can accidentally come into contact with them.
  • do not share your toothbrush, razors, hair clippers, nail clippers or scissors, sponges or towels which may have microscopic traces of your blood on the
  • keep cuts covered
  • use a condom during sexual activities

What is liver cirrhosis?

Cirrhosis describes severe scarring of your liver. Instead of it being pink and smooth, it will look lumpy and have an uneven outline and it may not work as well as a healthy liver 

Some people have what is known as well-compensated cirrhosis which you can have for 10 – 40 years without having any problems and have the same life expectancy as someone who is healthy and who does not have the condition.

If you have what is known as decompensated cirrhosis, your liver will not be working as efficiently as it should.

This causes complications which require medical help including:

  • A build up of fluid that causes your ankles and abdomen to swell up (ascites)

  • Encephalopathy and confusion which is made worse if you are constipated or dehydrated, or if you also have a bacterial or fungal infection

  • Jaundice, which causes yellowing, particularly the whites of your eyes as well as the skin

  • Oesophageal varices – varicose veins in your gullet (which is the tube which takes food from your moth to your stomach) which may bleed. If you vomit blood, this is a medical emergency and you should go immediately to your nearest Emergency Department