New hepatitis B drug
THERE is a virus lurking among us that is 100 times more infectious than the HIV virus.
It is the hepatitis B virus, which causes infection and inflammation of the liver, and can go on to cause terrible damage to the organ, like
scarring and liver cancer.
In 5-10% of those infected by the hepatitis B virus, their bodies are unable to clear the virus and they end up with chronic hepatitis B.
About 5.24% of Malaysians have this chronic infection, and are at risk of long-term liver damage that may lead to liver transplant or even death.
The hepatitis B virus is the key culprit that causes destruction of the liver. Therefore, treatment is mainly targeted at suppressing the virus.
"The amount of hepatitis B virus in the blood (called viral load) is a risk factor for the disease to progress from chronic hepatitis B to liver
scarring," says Prof Dr Rosmawati Mohamed, consultant gastroenterologist and hepatologist.
"A higher virus level is associated with increasing risk of liver cirrhosis and liver cancer. Sustained viral suppression is the key to
reduction and prevention of liver injury and disease progression," she notes.
Many more patients are now able to achieve this goal, thanks to new antiviral agents with better safety, efficacy and resistance profiles.
The newest oral medication, entecavir, has just been approved in Malaysia. A potent and selective inhibitor of the hepatitis B virus,
entecavir showed good results when it was studied for its efficacy in reducing the hepatitis B virus, improving liver biopsy and bringing liver
function back to normal.
"Its side effect profile is similar to that of lamivudine (the current recommended medication). The most common side effects seen with both
these drugs were headaches and flu-like symptoms," Prof Rosmawati says, adding
that these may or may not have been caused by the medications.
The big question is whether patients on entecavir will encounter drug resistance, which has been a problem for many patients on the older oral
Prof Rosmawati assures that things are better with entecavir. "In those patients who had no prior treatment with hepatitis B therapy, there
was no resistance after one year of treatment with entecavir. In those who received prior treatment, 1% of patients showed resistance to
She stresses the importance of early detection of chronic hepatitis B, so that antiviral medication can be given as soon as possible.
Some patients cannot immediately receive medication, because they may not show viral replication or active liver disease. However, they should still
be followed up on a regular basis to track the activity of the virus in the body. When the disease becomes active later, usually in young adulthood,
then treatment can start.
"Treatment is not indicated for everyone at one particular time," reminds Prof Rosmawati.
If you have hepatitis B, make sure you take your medication as prescribed, and see your doctor for regular checkups.
If you don't know whether you carry the hepatitis B virus, go for a test at least once -- it's knowledge that could save your life.