Hepatitis E virus

- Improving sanitation is the most important measure which consists

of proper treatment & disposal of human waste, higher standards for
public water supplies, improved personal hygiene procedures &
Sanitary food preparation .

- A vaccine based on recombinant viral protein has been developed

& recently tested in a high risk population (military personnel of a
developing country). The vaccine appeared to de effective & safe but
further studies are needed to assess the long term protection of this
vaccine.

Recent approaches in treatment & prevention of hepatitis

Treatment of hepatitis B:-

- Current treatments for hepatitis B are very effective at controlling

or suppressing the HBV. However HB treatment only rarely leads to
(cure).

- There are 5 drugs approved by FDA for use against HBV, these are
:-

1- Interferon alfa (Intron A)

2- Lamivudine (EPIVIR)

3- Adefovir (HEPSERA)

4- Entecavir (BARACLUDE)

5- Pegylated interferone alfa - 2a .

- Interferon works by helping the body's immune system fight
infection. Antivirals work by stopping the virus from replication.

- Interferons are given by injection. The other antiviral drugs are

given by mouth in pills or liquid form.

- Not every one with hepatitis B needs treatment. Treatment should

be only considered in those with active liver disease (liver enzymes,
HBV detected in blood & damage shown on liver biopsy).

- Chances of responding to treatment:-

* Almost all patients can achieve an initial lowering of blood levels

of HBV DNA & Liver enzymes.

* Treatment with oral therapy can keep viral levels low & liver
enzymes normal over prolonged periods.

* Treatment with Interferone can lead to loss of HBeAg in about one

third of patients.

-Duration of treatment:-

* Interferone is given for 6-12 months.

* Oral drugs may need to be given beyond one year depending on

response.

- Treatment of decompensated cirrhosis:-

* Interferone is contraindicated in these patients. Lamivudine is

the 1st choice in patient with active viral replication. Lamivudine
may reduce or delay the need for liver transplantation. In contrast,
the benefit of Lamivudine in patients with advanced cirrhosis &
 inactive viral replication is doubtful & shouldn’t be used in these
circumstances

* Treatment of cirrhosis is mainly symptomatic:-

* Ascitis:-

- Furosemide (lasix)

- Spironolactone (Aldactone)

* Encephalopathy :-

- lactulose

- Rifaximin.

* Portal hypertension & varices:-

- Propranolol (indral)

- Nadolol

* Spontaneous bacterial peritonitis (SBP) prophylaxis & treatment:-

- Trimethoprim – sulfamethoxazole.

- Fluroquinolones.

* Treatment of HB in pregnant women:-

Some recommended the use of lamivudine in pregnant women

with HBV DNA levels to reduce the risk of neonatal
transmission. To date, there are no reports of fetal injuries due to
Lamivudine. A single study has shown that if the HBV DNA
 levels are very high, the rate of maternal- fetal transmission is
approximately 30% despite neonatal vaccination.

* Treatment of hepatitis C:-

- Hepatitis C is very much a treatable condition .

- Treatment is with interferone (shots) & ribavirine

(capsules)

- Not every one with hepatitis C needs treatment. Only

patient with active liver disease or with scarring to liver should
be treated as long as they don’t have conditions that prevent
them from being treated successfully.

- In patient with confirmed HCV infection, genotype

testing is generally recommended. HCV genotype testing is
used to determine the required length & potential response to
interferone - based therapy.

- Chances of responding to treatment:-

About one half of treated patients clear HCV if they take a

complete course of treatment.

- Duration of treament:- depend on genotype:-

* For genotype 1→ A full year is needed.

* For genotype 2 & 3 → six months are sufficient.

- Some new studies has shown higher success rates when the
antiviral drug "Amantadine" is added to interferone & ribavirine.
This is called (Triple therapy). This may be especially helpful for
non - responding patients to interferone & ribavirine only.

* New additions used in treatment of both HB & HC:-

-Bile acids:-

* Bile acids may improve liver biochemistry of patients with HB or

HC but there is insufficient evidence about long term beneficial
effects.

* Bile acids may decrease serum transaminase activities in patients

with acute hepatitis B, chronic hepatitis B or chronic hepatitis C.
However, bile acids have no effects in eradicating viral markers.

There is insufficient evidence either to support or to refute effects on

long term outcomes e.g. heapatocellular carcinoma, decompensated
cirrhosis & / or liver related mortality.

- Transfer factor (TF):-

* The results obtained from adult patients receiving TF along with

conventional therapy attests to a high effectiveness of cellular
cytokines use in this kind of pathology. Along with normalization of
biochemical values & the decrease of viral load, all patients
registered a marked improvement of general state, were more
efficient & didn’t experience excessive fatigue & there was no
discomfort in Right hypochondrium.

* What is Transfer factor?

The colostrum is the milk produced in the 1st few days after child
birth. Colostrum contains a potent array of immune factors which
can be passed from mother to child & is available in supplement
form in health food stores from bovine sources. The principle
immune factor in colostrum is a group of molecules called TF. It can
also be derived from eggyolk protein & human WBCs.

* Post - exposure prophylaxis against HB & HC:-

- Needle stick injuries &wounds should be washed with soap &

water & shouldn’t be squeezed. Mucous membranes should be
flushed with water.

- For HB:- Initiation of HB vaccine series within 12-24h of an

exposure has been demonstrated to be 70 - 90 % effective in
preventing HBV infection.

- For HC:- People who have HC can get into another infection of
one of other genotypes which can make the person sicker so they
should follow general guidelines for protection.