If you know you've been exposed to HBV, call your doctor immediately. Receiving an injection of hepatitis B immune globulin within 24 hours of coming in contact with the virus may help protect you from developing hepatitis B. You should also receive the first in a series of three shots of the hepatitis B vaccine.

Once you've developed chronic hepatitis B, few treatment options exist. In some cases — especially if you don't have signs and symptoms or liver damage — your doctor may suggest monitoring, rather than treating, your condition. In other cases, your doctor may recommend treatment with antiviral medications. When liver damage is severe, liver transplantation may be the only option.

Drug therapies

Doctors use four drugs to treat chronic HBV infection:

• Interferon. Your body naturally produces interferon to help protect against invading organisms such as viruses. Giving additional interferon that has been manufactured in a laboratory may stimulate your body's immune response to HBV and help prevent the virus from replicating in your cells. Not everyone is a candidate for treatment with interferon. In a few cases, interferon eliminates the virus completely, although the infection can later return. Interferon has a number of side effects — many of which resemble signs and symptoms of hepatitis B. These include depression, fatigue, muscle pains, body aches, fever and nausea. Signs and symptoms are usually worse during the first two weeks of treatment and in the first four to six hours after receiving an injection of interferon. A more serious side effect that may occur over time is a decreased production of red blood cells. Two interferon medications are available, interferon alfa-2b (Intron A) and peginterferon alfa-2a (Pegasys). Intron A is administered by injection several times a week. Pegasys is given by injection once a week.

• Lamivudine (Epivir-HBV). This antiviral medication helps prevent HBV from replicating in your cells. It's usually taken in pill form once a day. Side effects during treatment are generally minimal, but you may experience a severe worsening of symptoms when you stop taking the drug. Lamivudine can also cause a drug-resistant form of HBV to develop, particularly when taken as a long-term treatment. Tell your doctor if you have had any kidney problems or history of pancreatitis before starting this medication. If you experience worsening jaundice or any unusual bruising, bleeding or fatigue while taking lamivudine, call your doctor right away.

• Adefovir dipivoxil (Hepsera). This drug, taken by pill once daily, also helps prevent HBV from replicating in your cells. An added benefit is that it's effective in people who are resistant to lamivudine. Like lamivudine, side effects during treatment usually are minimal, but symptoms may worsen when you go off the medication. And Hepsera may cause kidney toxicity.

• Entecavir (Baraclude). This antiviral medication, approved by the Food and Drug Administration (FDA) in March 2005, is taken once a day in pill form. Studies comparing Baraclude with lamivudine found Baraclude to be more effective. Baraclude may cause serious worsening of symptoms when the drug is discontinued.

• Telbivudine (Tyzeka, Sebivo). This antiviral medication, approved by the FDA in October 2006, is similar to lamivudine, though slightly stronger. Like lamivudine, telbivudine is also associated with a high rate of resistance.

Liver transplantation

When your liver has been severely damaged, a liver transplant may be an option. The encouraging news is that these transplants are increasingly successful. Unfortunately, not enough donor organs are available for every person who needs a transplant.

Treatment of Hepatitis C

A diagnosis of HCV doesn't necessarily mean you need treatment.
You may need treatment if
The National Institutes of Health recommends treatment for HCV if you have:

• A positive test result indicating hepatitis C virus circulating in your bloodstream

• A biopsy that indicates significant liver damage

• Elevated levels of a liver enzyme called alanine aminotransferase (ALT) in your blood

You may not need treatment if

If you have only slight liver abnormalities, your doctor may decide against medical treatment because your long-term risk of developing a serious disease is slight, and the side effects of treatment can be severe.

On the other hand, because there's no foolproof way to know whether you'll develop liver disease later on, your doctor may recommend fighting the virus. Improved treatment methods and a higher success rate in fighting hepatitis sometimes tip the balance in favor of more aggressive approaches.

Drug therapies — pegylated interferon alfa and ribavirin

The standard of care for hepatitis C treatment is weekly injections of a drug called pegylated interferon alfa combined with twice-daily oral doses of ribavirin (Rebetol) — a broad-spectrum antiviral agent. Two pegylated interferon medications are available, peginterferon alfa-2b (Peg-Intron) and peginterferon alfa-2a (Pegasys).
The goal of HCV treatment is to clear the virus from your bloodstream. Combined pegylated interferon and ribavirin clear HCV infection in 40 percent to 80 percent of those treated. It's success often depends on the type of infection. For example, this treatment clears infection in up to half the people with genotype 1 — the most common genotype found in the United States — and in up to 80 percent of those with genotypes 2 and 3.

Duration of treatment

If you have genotype 1 HCV, your doctor may recommend a course of relatively high-dose medications for 48 weeks. If you have genotype 2 or genotype 3, a 24-week course of medications at a lower dose may be adequate.
If one course of combined pegylated interferon and ribavirin doesn't clear HCV from your bloodstream, your doctor may recommend a second course of combination therapy. If your viral load declined during the first round of medications, a second round may clear the virus completely. Even if there was no change in your viral load during the first course of treatment, a second course may help reduce the damage HCV does to your liver.
Side effects of medications
Interferon side effects include severe flu-like symptoms, irritability, depression, concentration and memory problems, skin irritation, fatigue and insomnia.
Ribavirin can cause a low red blood cell count (anemia), itchiness, nasal congestion, skin irritation, fatigue and birth defects.
Combination therapy including pegylated interferon and ribavirin may cause psychosis or suicidal behavior in a small number of people. For this reason, treatment with interferon isn't recommended if you have a history of uncontrolled major depression. You're also not a good candidate for this treatment if you're pregnant or have untreated thyroid disease, low blood cell counts or autoimmune disease, or if you drink alcohol or use drugs and are unwilling to stop or seek help with stopping.
Side effects from combined pegylated interferon and ribavirin are generally most severe during the first few weeks of treatment, and may be improved with pain relief medications and antidepressants. However, some people taking interferon need their dosage reduced because of severe side effects, and others must stop treatment.

Liver transplantation

The best treatment for people with end-stage liver disease is liver transplantation. However, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive transplants.
These developments include the donation of liver segments from living relatives, splitting one donated liver between two recipients, new organ allocation policies and, especially, new approaches to liver transplants for people with HCV.
Until recently, HCV-infected livers were routinely discarded. But studies show that people already infected with HCV who receive livers from HCV-positive donors can do as well as if they had received a liver not infected with the virus. This may mean that many more livers will become available for people with hepatitis C.
Liver transplantation does not cure HCV. The majority of people with hepatitis C who receive liver transplants experience a recurrence of the virus. Those with HCV who receive liver transplants also are at accelerated risk of developing cirrhosis within five years. Treatment with HCV-fighting medications may help prevent a recurrence of infection or treat recurrent illness that develops after a liver transplant. However, the effectiveness of this type of treatment after a liver transplant is unclear.
Immunizations
Your doctor will likely recommend that you are vaccinated against the hepatitis A and B viruses. These are separate viruses that can also cause liver damage and complicate treatment of hepatitis C.