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Hepatitis B

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Related Terms
  • Acute liver disease, acute liver failure, acute hepatitis, AIDS, antibodies, anti-HBc, anti-HBs, biliary epithelial cells, blood test, chronic hepatitis, chronic liver disease, cirrhosis, delta virus, E-antigen test, endothelial cells, fulminant hepatic failure, HbsAg, HCC, HDV, hepatic failure, hepatitis, hepatitis A, hepatitis B core antigen, hepatitis B surface antigens, hepatitis C, hepatitis D, hepatitis E, hepatitis B surface antigen, hepatitis D, hepatitis viral infection, hepatocellular carcinoma, hepatocytes, hepatoprotection, HIV, infection, liver, liver cancer, liver cirrhosis, liver disease, liver failure, liver inflammation, liver regeneration, sexually transmitted disease, STD, viral hepatitis, viral infection, viral hepatitis type B, virus.

Background
  • The liver is located on the right side of the abdomen, just below the lower ribs. The liver is primarily responsible for filtering most of the nutrients that are absorbed in the intestines, as well as removing drugs, alcohol and other harmful substances from the bloodstream. The liver also produces bile, a greenish fluid stored in the gallbladder that helps digest fats. In addition, the liver also produces cholesterol, blood-clotting factors and other proteins.
  • The liver is able to regenerate or repair up to two-thirds of injured tissue, including hepatocytes, biliary epithelial cells and endothelial cells. Healthy cells take over the function of damaged cells, either indefinitely or until the damage is repaired.
  • The Hepatitis B virus (HBV) causes a serious liver infection. The infection can become chronic in some people and lead to liver failure, liver cancer, cirrhosis (a condition that causes permanent scarring and damage to the liver) or death.
  • The hepatitis B virus is transmitted through contact with bodily fluids, such as blood and semen, of someone who is infected. Even though HBV is transmitted the same way as the human immunodeficiency virus (HIV), the virus that causes AIDS, HBV is nearly 100 times as infectious as HIV. Individuals of any age, race, nationality, gender or sexual orientation can become infected with HBV. Also, women who have HBV can transmit the infection to their babies during childbirth. When the infection is passed from mother to fetus, it is called vertical transmission.
  • Certain individuals have an increased risk of developing the disease. Individuals who are more likely to become infected with HBV are those who use intravenous (IV) drugs, have unprotected sex and are born in or travel to parts of the world where hepatitis B is prevalent (like sub-Saharan Africa, Southeast Asia, the Amazon Basin, the Pacific Islands and the Middle East).
  • Most people who become infected as adults recover completely from HBV, even if their symptoms are severe. However, infants and children are more likely to develop chronic, long-term infections.
  • While there is no cure for HBV, the hepatitis B vaccine can prevent the disease. Also, infected individuals can take precautions to help prevent HBV from spreading to others by getting testing for the virus, using protection during sexual contact and not sharing needles.
  • According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 1.25 million Americans have chronic hepatitis. About 20-30% of hepatitis patients acquired their infection during childhood. The incidence per year has declined from an average of 260,000 in the 1980s to about 60,000 in 2004. The most significant decline has occurred among children and adolescents as a result of the routine hepatitis B vaccination.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Centers for Disease Control and Prevention (CDC). Viral Hepatitis B. . Accessed March 29, 2009.
  2. Hepatitis Foundation International. Caring for Your Liver. . Accessed March 29, 2009.
  3. National Digestive Diseases Information Clearinghouse (NDDIC). Viral Hepatitis: A Through E and Beyond. . Accessed March 29, 2009.
  4. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed March 29, 2009.
  5. World Health Organization (WHO). Hepatitis B. . Accessed March 29, 2009.
  6. The Hepatitis Information Network. . Accessed March 29, 2009.

Causes
  • A virus that attacks the liver causes hepatitis B. The virus, known as hepatitis B virus (HBV), can cause a life-long infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death.

Symptoms
  • Hepatitis B is contagious even when symptoms do not appear. According to the U.S. Centers for Disease Control and Prevention (CDC), about 30% of patients with chronic hepatitis show no signs or symptoms. Hepatitis B symptoms are less common in infants and children than adults.
  • Symptomatic patients usually experience the first symptoms four to six weeks after infection, and they can range from mild to severe. Common symptoms include loss of appetite, nausea and vomiting, weakness and fatigue, abdominal pain (especially near the liver), dark urine, jaundice (yellowing of the skin and eyes) and joint pain.

Diagnosis
  • General:
  • Pregnant women should be tested for the hepatitis B virus (HBV) early in pregnancy. Individuals who are knowingly exposed to the virus should also be tested.
  • Individuals who adopt children from regions of the world where hepatitis B is prevalent are advised to have their children tested when they arrive in the United States. Tests performed in other countries may not always be reliable.
  • Tests are performed in a physician's office, a hospital or public health clinic. Many public health clinics offer free testing for HBV and other sexually transmitted diseases (STDs).
  • Blood tests:
  • Hepatitis B surface antigen (HBsAg): The outer surface of the virus has Hepatitis B surface antigens (HbsAg). Patients who test positive for this antigen can easily pass the virus to others. A negative test means the individual is probably not infected. However, a false-negative result may occur if the test was performed soon after the patient was initially exposed to the virus.
  • Antibody to hepatitis B surface antigens (anti-HBs): If individuals have antibodies to HBV, they will test positive for hepatitis B surface antigens. A positive result may indicate that the individual has previously been infected with HBV or the individual has been vaccinated. Patients who test positive cannot become infected.
  • Antibody to hepatitis B core antigen (anti-HBc): The blood test for antibodies to the hepatitis B core antigen identifies individuals who have a chronic infection. However, the results can sometimes be ambiguous. Individuals who test positive may have a chronic and contagious infection, or they may be may be recovering from an acute infection or have a slight immunity to HBV that cannot otherwise be detected. The interpretation of this test depends on the results of the other two blood tests.
  • Additional tests:
  • Once a patient is diagnosed with hepatitis B, a qualified healthcare provider may perform additional tests to determine the severity of the infection and condition of the liver.
  • E-antigen test: An E-antigen blood test is used to determine whether a protein that is secreted by HBV-infected cells is present. A positive result means that the patient has high levels of the virus in the blood, and it is very contagious. If the test is negative, the patient has lower levels of HBV in the blood and the virus is less contagious.
  • Liver enzymes: Another blood test may be performed to check for elevated levels of liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These enzymes leak into the bloodstream when liver cells are injured.
  • Alpha-fetoprotein (AFP) test: If the patient has high levels of the alpha-fetoprotein in the blood, it may be a sign of liver cancer. Healthy adult males and non-pregnant females typically have less than 40 micrograms of alpha-fetoprotein per liter of blood.
  • Liver ultrasound or computerized tomography (CT) scan: A liver ultrasound or computerized tomography (CT) scan may be performed to detect liver problems. The radiologist analyzes the detailed images of the liver for signs of complications like cirrhosis or liver cancer.
  • Liver biopsy: A liver biopsy may be performed to determine the extent of liver damage and to determine the best treatment option for the patient. During the procedure, a needle is inserted into the liver and a small tissue sample is removed. The tissue is then analyzed under a microscope in a laboratory.

Treatment
  • General: Individuals who knowingly have been exposed to the hepatitis B virus (HBV) should consult their healthcare providers as soon as possible. Patients who receive an injection of hepatitis B immune globulin within 24 hours of exposure to the virus may not develop HBV infection. Patients should also receive the first of three injections of the hepatitis B vaccine.
  • There are few treatment options for patients with chronic hepatitis B. In some cases, the doctor may suggest monitoring the patient's condition instead of treating it. In other instances, the doctor may recommend antiviral treatment. When liver damage is severe, a liver transplantation may be the only treatment option.
  • Alcohol avoidance: Individuals who have been diagnosed with hepatitis should avoid drinking alcohol because it speeds the progression of liver disease.
  • Interferon: The body naturally produces interferon to fight against invading organisms, including viruses. Administering additional synthetic interferon may stimulate the body's immune response to HBV and help prevent the virus from spreading. Two interferon medications are available including, 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.
  • Not everyone is a candidate for interferon treatment. In a few cases, interferon has successfully eliminated the virus completely. However, the infection can return in the future. Several side effects are associated with interferon, including depression, fatigue, muscle pain, body aches, fever and nausea. Interferon may also cause a decreased production of red blood cells. 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.
  • Lamivudine (Epivir-HBV®): Lamivudine (Epivir-HBV®) is an antiviral medication that helps prevent HBV from replicating in the body's cells. The medication is usually taken in tablet form once daily. Side effects during treatment are generally mild, but some patients may experience a severe worsening of symptoms when they stop taking the medication. Patients should tell their healthcare providers if they have had any kidney problems or history of pancreatitis before starting this medication. Patients should call their healthcare providers immediately if they experience a worsening of jaundice (yellowing of the skin and eyes) or if they experience any unusual bruising, bleeding or fatigue while taking the medication.
  • Adefovir dipivoxil (Hepsera®): Adefovir dipivoxil (Hepsera®) is a tablet taken orally once a day to help prevent HBV from replicating inside the body's cells. This drug is effective in patients who are resistant to lamivudine. Like lamivudine, side effects are generally mild, but symptoms may worsen when treatment is stopped. Hepsera® may cause kidney toxicity in patients with underlying kidney disease. A change in the amount of urine produced or blood in the urine may indicate kidney toxicity. Other side effects may include weakness, headache, fever, increased cough, nausea, vomiting, diarrhea or gas.
  • Entecavir (Baraclude®): Entecavir (Baraclude®) is an antiviral medication that was approved by the U.S. Food and Drug Administration (FDA) in March 2005. This medication is taken orally once a day. Studies comparing entecavir to lamivudine found that entecavir was more effective. Baraclude® may cause symptoms of hepatitis to worsen once medication is discontinued.
  • Liver transplant: When the liver has been severely damaged, a liver transplant may be the only treatment option. Liver transplants are increasingly successful. However, there are not enough donor organs available for every patient who needs a transplant, and not all patients are suitable transplant candidates.

Integrative therapies
  • Good scientific evidence:
  • Cordyceps: In traditional Chinese medicine, cordyceps has been used to support and improve liver function. Cordyceps may stimulate the immune system and improve serum gamma globulin levels in hepatitis B patients. Currently, there is insufficient evidence to recommend for or against the use of cordyceps for chronic hepatitis B. However, early study results are promising. Additional research of cordyceps and current hepatitis treatments is needed.
  • Avoid if allergic or hypersensitive to cordyceps, mold or fungi. Use cautiously with diabetes, bleeding disorders or taking anticoagulant medications, with prostate conditions, if taking immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.
  • Milk thistle: Multiple studies from Europe suggest benefits of oral milk thistle for cirrhosis. In experiments up to five years long, milk thistle has improved liver function and decreased the number of deaths that occur in cirrhotic patients. Although these results are promising, most studies have been poorly designed. Further research is necessary before a strong recommendation can be made.
  • In addition, several studies of oral milk thistle for chronic hepatitis caused by viruses or alcohol report improvements in liver tests. However, most studies have been small and poorly designed. More research is needed before a recommendation can be made.
  • Use cautiously if allergic to plants in the aster family (Compositea, Asteraceae), daisies, artichoke, common thistle, or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
  • Probiotics: Liver cirrhosis may be accompanied by an imbalance of intestinal bacteria flora. Probiotic supplementation in cirrhosis patients has been found to reduce the level of fecal acidity (pH) and fecal and blood ammonia, which are beneficial changes.
  • Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
  • Unclear or conflicting scientific evidence:
  • Astragalus: Anti-viral activity has been reported with the use of astragalus in laboratory and animal studies. Limited human and animal research has examined the use of astragalus for viral infections in the liver (hepatitis B and C). However, most studies have been small and poorly designed. Due to a lack of well-designed research, no firm conclusions can be drawn. Clinical data suggests that astragalus may be effective in treating cirrhosis. Further research is needed to better understand the use of astragalus for liver protection.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Ayurveda: Ayurveda is an integrated system of specific theories and techniques employing diet, herbs, exercise, meditation, yoga and massage or bodywork. Clinical evidence suggests that the traditional herbal preparation Kamalahar may reduce clinical signs as well as indicators of liver damage in acute viral hepatitis. Kamalahar contains Tecoma undulate, Phyllanthus urinaria, Embelia ribes, Taraxacum officinale, Nyctanthes arbortistis, and Terminalia arjuna. The root powder from the herb Picrorhiza kurroa has also been shown to improve levels of bilirubin, SGOT (serum glutamic-oxaloacetic transaminase) and serum glutamic pyruvic transaminase (SGPT) in viral hepatitis. Further research is needed before a firm conclusion can be made.
  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.
  • Biotin: Biotin is an essential water-soluble B vitamin. Antioxidant therapy with biotin, vitamins A-E, selenium, zinc, manganese, copper, magnesium, folic acid, and coenzyme Q10 was not shown to improve survival rates for hepatitis. More research with biotin alone is needed. Avoid if hypersensitive to constituents of biotin supplements.
  • Bupleurum: For more than 2,000 years bupleurum has been used in Asia to treat hepatitis, cirrhosis and other conditions associated with inflammation. A high-quality clinical trial and several small recent clinical reports suggest that bupleurum and/or an herbal combination formula containing bupleurum may be helpful in the treatment of chronic hepatitis. However, studies to date are small and not all well controlled. Further research is warranted to determine whether bupleurum can effectively treat hepatitis.
  • Avoid if allergic or hypersensitive to bupleurum, Apiaceae or Umbelliferae (carrot) families, snakeroot, cow parsnip, or poison hemlock. Use cautiously if operating motor vehicles or hazardous machinery. Use cautiously with low blood pressure, diabetes, or edema. Use cautiously with a history of bleeding, hemostatic disorders, or drug-related hemostatic disorders. Use cautiously if taking blood thinners. Avoid if pregnant or breastfeeding.
  • Capers: There is limited evidence of the effect of capers alone on cirrhosis. Additional studies are needed.
  • Capers are generally considered to be safe. Avoid with allergy or sensitivity to capers or mustard oil. There are limited reports of side effects with capers. Use cautiously with diabetes or low blood sugar or in those taking drugs, herbs, or supplements that lower blood sugar. Use cautiously with low blood pressure or if taking drugs, herbs, or supplements that lower blood pressure. Use cautiously in patients prone to iron overload. Use cautiously if taking diuretics. Use cautiously if pregnant or breastfeeding.
  • Chicory: Chicory (Chichorium intybus) has been suggested as a possible treatment for chronic hepatitis. However, further research is needed before a definitive conclusion can be made.
  • Avoid if allergic/hypersensitive to chicory or members of the Asteraceae or Compositae family, including ragweed, chrysanthemums, marigolds, and daisies. Use cautiously if taking drugs or herbs metabolized by cytochrome P450 enzymes. Use cautiously with gallstones. Avoid if pregnant or breastfeeding.
  • Choline: Studies have assessed the use of choline for acute viral hepatitis, many of which have been poorly designed. There is currently insufficient evidence available to determine whether choline can effectively treat hepatitis.
  • Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Cordyceps: In traditional Chinese medicine, cordyceps has been used to support and improve liver function. In two studies using herbal combinations that included cordyceps, liver and immune function were improved. However, as these studies used combination treatments, the effect of cordyceps alone for treatment of cirrhosis is currently unknown.
  • Avoid if allergic or hypersensitive to cordyceps, mold or fungi. Use cautiously with diabetes, bleeding disorders or taking anticoagulant medications, with prostate conditions, if taking immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.
  • Dandelion: Human study reports improved liver function in patients with chronic hepatitis B after taking a combination herbal preparation containing dandelion root, called Jiedu Yanggan Gao (also including Artemisia capillaris, Taraxacum mongolicum, Plantago seed, Cephalanoplos segetum, Hedyotis diffusa, Flos chrysanthemi indici, Smilax glabra, Astragalus membranaceus, Salviae miltiorrhizae, Fructus polygonii orientalis, Radix paeoniae alba, and Polygonatum sibiricum). Because multiple herbs were used the effects of dandelion are unclear.
  • Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Potassium blood levels should be monitored. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Danshen: Some studies suggest that danshen may provide benefits for treating liver diseases such as cirrhosis, fibrosis and hepatitis B. However, it is unclear whether there are any clinically significant effects of danshen in patients with these conditions.
  • Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin or hypotensives including ACE inhibitors such as captopril, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure and following cerebal ischemia. Avoid if pregnant or breastfeeding.
  • Eyebright: Limited evidence from animal studies suggests that aucubin, a constituent of eyebright, may inhibit hepatic RNA and protein syntheses in vivo. These properties have been associated with protective effects in carbon tetrachloride and alpha-amanitin-induced hepatotoxicity in mice. Conversion of aucubin to its algycone appears to be a prerequisite step for these hepatic effects to occur. The clinical relevance of these finding to humans is unclear, and there is currently insufficient evidence to determine whether eyebright is an effective agent for hepatoprotection.
  • Avoid if allergic to eyebright, any of its constituents, or members of the Scrophulariaceae family. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.
  • Germanium: There is limited evidence for the use of propagermanium (an organogermanium) in the treatment of hepatitis B. Additional research is warranted in this area.
  • Avoid if allergic or hypersensitive to germanium, its compounds or germanium-containing plants. Avoid if pregnant or breastfeeding.
  • Ginseng: There is currently a lack of sufficient evidence to recommend either American ginseng or Panax ginseng as an agent for hepatoprotection. Laboratory study investigated compound K, a ginseng metabolite that shows promise in protecting against liver injury. Additional human studies are warranted in this area. Early studies show that ginseng may improve some aspects of liver function but not others. More research is needed regarding chronic hepatitis B.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Gotu kola: Study results of gotu kola (Centella asiatica) for liver disease are mixed. Further research is needed before a recommendation can be made for liver cirrhosis.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • L-carnitine: Although early evidence suggests that L-carnitine may effectively treat cirrhosis, further research is needed to confirm these results.
  • Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Licorice: The licorice extracts DGL and carbenoxolone have been proposed as possible therapies for viral hepatitis. Further research is needed before a firm conclusion can be made.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Liver extract: Liver extract seems to stimulate liver function and may be of benefit in treatment of hepatic disorders such as chronic hepatitis. More research is needed to compare liver extract to other hepatostimulatory treatments.
  • Avoid if allergic or hypersensitive to liver extract or its constituents. Use cautiously if taking antacids or with acid reflux. Use cautiously with clotting disorders, compromised immune function, and abnormal iron levels. Use cautiously if taking antihypercholesterolemic drugs (drugs that affect blood cholesterol), antiviral agents, especially interferon, or any agents for cancer. Use cautiously as raw liver may contain liver flukes or the bacterium, Vibrio fetus. Use cautiously in hepatopathic patients with reduced human growth hormone metabolic clearance rate. Avoid liver extract with iron metabolism disorders or iron shortage disorders, such as hemochromatosis. Avoid liver extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Avoid if sensitive to liver extract or any of its components, as liver extract therapy has caused severe anaphylactic shock. Avoid if pregnant or breastfeeding.
  • Milk thistle: Milk thistle (Silybum marianum) has been used medicinally for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. Research on milk thistle for acute viral hepatitis has not provided clear results, and milk thistle cannot be recommended for this potentially life-threatening condition at this time.
  • Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used during pregnancy or breastfeeding unless otherwise directed by a doctor.
  • Mistletoe: In preliminary research, some patients achieved complete elimination of the hepatitis virus after treatment with Viscum album, although these studies were not well designed. A small exploratory trial investigated effects of mistletoe on liver function, reduction of viral load and inflammation, and maintaining quality of life by the immunomodulatory and/or cytotoxic actions of mistletoe extracts, but little effect was seen. Larger, well-designed clinical trials are needed to resolve this conflicting data.
  • Avoid if allergic to plants in the aster family (Compositea, Asteraceae), daisies, artichoke, common thistle, or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
  • Peony: The peony species Paeonia lactiflora Pallas has been used in traditional Chinese medicine (TCM) to treat liver disease. In humans, Paeonia rubra root has been given to patients with liver cirrhosis. Larger controlled trials of higher methodological quality are necessary to substantiate the positive results of this small case series.
  • Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
  • Reishi mushroom: Based on positive laboratory evidence, a clinical trial using Ganopoly® or placebo was conducted in chronic hepatitis B patients. Ganopoly® treatment decreased levels of hepatitis B virus (HBV) DNA. Further well-designed research is needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.
  • Rhubarb: Two studies have been conducted on rhubarb and its effects on hepatitis. In the case series, high doses of rhubarb decreased the symptoms and serum levels associated with hepatitis. However, additional, high-quality studies are needed to establish rhubarb's effects.
  • Avoid if allergic/hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children under age 12 due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, coagulation therapy, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anti-psychotic drugs or oral drugs, herbs or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.
  • Safflower: EH0202 is a traditional Japanese Kampo therapy containing safflower seed extract and is used for immunostimulation. More studies with safflower alone are needed to better define safflower's effect on chronic hepatitis.
  • Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants, or pentobarbital. Use cautiously with diabetes, hypotension, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
  • SAMe: Preliminary evidence from meta-analyses and randomized clinical trials suggests that SAMe may normalize levels of liver enzymes in individuals with liver disease. Well-designed clinical trials, with appropriate subject number in homogenous populations are required before a definitive conclusion can be made.
  • Avoid if allergic or hypersensitive to SAMe. Use cautiously with diabetes and anxiety disorders, or women in their third trimester of pregnancy. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding.
  • Schisandra: The efficacy of schisandra as a hepatoprotective agent has been demonstrated in multiple studies. Based on these observations, schisandra has been suggested as a potential treatment for liver disease. Future studies are warranted to assess the long-term efficacy and safety of schisandra compared to standard therapies.
  • Use cautiously during pregnancy or lactation or in patients with bleeding disorders, seizure disorders, high intracranial pressure, high blood pressure, skin diseases, gastoeseophageal reflux or peptic ulcer disease, neurological disorders, or diabetes. Avoid in patients allergic to schisandra, any of its constituents, or other members of the Schisandraceae family. Allergic skin rashes and urticaria has been reported in some patients.
  • Sea buckthorn: Sea buckthorn extract may improve liver health in people with cirrhosis. Although the results are intriguing, additional higher quality research is needed in this area.
  • Avoid if allergic or hypersensitive to sea buckthorn, its constituents, or members of the Elaeagnaceae family. Use cautiously if taking angiotensin converting enzyme (ACE) inhibitors, anticoagulants and antiplatelet agents (blood thinners), antineoplastics (anticancer agents), or cyclophosphamide or farmorubicin. Avoid higher doses than food amounts if pregnant or breastfeeding.
  • Selenium: Selenium supplementation has been studied in various liver disorders, including hepatitis, with mixed results. Further research is needed to establish selenium's effects on liver disease.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Taurine: Early studies have found that taurine supplementation has the potential to modify the conjugation of bile acids, potentially modifying the disease. Furthermore, taurine has been examined as an adjunct to ursodeoxycholate (UDCA) in the treatment of liver disease. Results from these early studies suggest that conjugation of bile acids can be modified and that taurine as an adjunct to UDCA does not offer more benefits. More recent studies are investigating the effect of tauroursodeoxycholate (TUDCA) in liver disease treatment. As of yet, however, the evidence in support of taurine in liver disease is minimal and well-designed clinical trials with positive results are needed before a firm conclusion can be made.
  • Taurine is an amino acid and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, coagulation disorders, potential for mania, or epilepsy. Avoid consuming alcohol or exercising after consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
  • Thymus extract: Preliminary evidence suggests that thymus extract may offer benefit to individuals with liver disease. More well-designed clinical trials are required.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) may provide protection for liver disease. However, more studies are needed before recommendations can be made.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. A qualified healthcare professional should be consulted before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources.
  • Turmeric: In traditional Indian Ayurvedic medicine, turmeric has been used to tone the liver. Early research suggests that turmeric may have a protective effect on the liver. More research is needed to better determine the effectiveness of turmeric for hepatoprotection.
  • Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
  • Vitamin E: In patients with hepatitis on antiviral therapy, vitamin E has been proposed to prevent inflammation. More studies are needed to examine the effects of vitamin E in chronic hepatitis.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant and breastfeeding women.
  • Fair negative scientific evidence:
  • Spirulina: Despite findings indicating potential hepatoprotective properties of spirulina, preliminary human study of spirulina for chronic viral hepatitis shows negative results. Additional high quality study is needed to confirm these findings.
  • Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; and if consuming a high-protein diet. Avoid in children and if pregnant or breastfeeding.

Prevention
  • Vaccination: Hepatitis B vaccination is the best way to prevent hepatitis B infection. A hepatitis B vaccine (Engerix-B®) has been available since 1982. It is administered in a series of three immunizations and provides more than 90% protection for both adults and children. The vaccine generally protects against the hepatitis B virus (HBV) for at least 15 years. Almost anyone can receive the vaccine, including infants, older adults and those with immune deficiencies. Infants usually receive the vaccine during the first year of life, with injections administered at two, four and nine months of age.
  • In the last decade, recombinant DNA technology has been used to produce the vaccine in the United States. Rather than using the blood of infected patients, the HBV antigen used in the vaccine is produced in a laboratory.
  • Side effects tend to be mild and may include weakness, fatigue, headache, nausea and soreness or swelling at the injection site. Although concerns have been raised that the HBV vaccine may increase the risk of autoimmune disease and sudden infant death syndrome (SIDS), studies have found no correlation.
  • Testing: Hepatitis B can be contagious, even when the patient is asymptomatic (experiences no symptoms). Therefore, it is recommended that individuals who think they have been exposed to the virus get tested. Pregnant women who suspect they have been exposed to the virus should also get tested because they can pass HBV to their babies.
  • Protected sex: Individuals should not engage in unprotected sex, especially if they do not know the health status of their partner. Avoid lambskin condoms because they do not prevent against STDs. Also, oil-based lubricants can weaken condoms and cause them to break.
  • Sterile needle use: While illicit drug use is illegal in the United States, individuals who use needles to inject drugs should use sterile needles and avoid sharing used needles with other people.

Complications
  • Hepatitis D: Anyone who has chronic hepatitis B is also susceptible to infection with another strain of viral hepatitis known as hepatitis D (formerly called delta virus). Hepatitis D virus can only infect cells if the hepatitis B virus (HBV) is present. Injection drug users who have hepatitis B are at the greatest risk.
  • Liver disease: Individuals with chronic HBV infection may develop serious liver diseases, such as cirrhosis (scarred, fibrous liver that is full of fat and not functioning properly) and liver cancer. Individuals who had HBV as an infant are at a greater risk of developing serious liver complications as an adult. Also, individuals who are infected with both hepatitis B and hepatitis D have an increased risk of developing cirrhosis or liver cancer, both of which can be fatal.
  • Liver failure: Individuals diagnosed with HBV are at risk of acute liver failure, which occurs when all the vital functions of the liver shut down. Liver failure occurs if cirrhosis is present in more than two-thirds of the liver. Liver failure requires a liver transplant and can be fatal.

Risk factors
  • Individuals who have unprotected sex with more than one partner.
  • Individuals who have unprotected sex with someone who is infected with HBV.
  • Individuals who have a sexually transmitted disease, such as gonorrhea or chlamydia.
  • Individuals who share needles during intravenous (IV) drug use.
  • Individuals who share a household with someone who has a chronic HBV infection. Close contact with an infected individual increases the likelihood of acquiring the viral infection.
  • Individuals who have a job that exposes them to human blood.
  • Individuals who have received a blood transfusion or blood products before 1970. It was not until after 1970 that the blood supply was routinely tested for HBV. Today, the risk of contracting HBV from donated blood is low.
  • Individuals who receive hemodialysis for end-stage renal disease.
  • Individuals who travel to regions of the world that have high infection rates of HBV, such as sub-Saharan Africa, Southeast Asia, the Amazon Basin, the Pacific Islands and the Middle East.
  • Adolescents or young adults residing in a U.S. correctional facility.
  • Newborns whose mothers are infected with HBV.
  • Anyone can potentially become infected with HBV, even if they have no known risk factors for the disease.

Acute and chronic forms
  • Acute: Acute hepatitis B lasts less than six months. If the infection is acute, the body's immune system is able to destroy the virus, and the patient should recover completely within a few months. Most patients who acquire HBV as adults are able to eradicate the infection.
  • Chronic: Chronic hepatitis B lasts six months or longer. The infection is chronic when the immune system is unable to fight off the virus. The infection may become lifelong and can potentially cause serious complications, such as cirrhosis, liver cancer, liver failure and death. Infants and many children between the ages of one and five become chronically infected. Chronic infection may go undetected for years, and possibly even decades. In most chronic cases, the individuals are unaware of the infection until a serious liver complication develops.

Different strains of hepatitis
  • Hepatitis A: Hepatitis A is transmitted primarily through food or water contaminated by feces from an infected person. In rare cases, it may spread via infected blood. Hepatitis A usually resolves without treatment in several weeks. However, there is a hepatitis A vaccine.
  • Hepatitis C: Hepatitis C is primarily spread via blood. It may also be transmitted through sexual contact and childbirth, although this occurs less often. Currently, there is no vaccine for hepatitis C. The only the way to prevent the disease is to reduce the risk of exposure to the virus. Individuals can minimize exposure to the virus by using protection during sexual contact and not sharing needles. According to the U.S. Centers for Disease Control and Prevention (CDC), individuals who underwent hemodialysis or received blood clotting factors before 1987 are at a high risk of developing Chronic Hepatitis C because blood products were not tested for hepatitis C before then. Chronic hepatitis C is treated with the drug peginterferon or a combination treatment with peginterferon and ribavirin. Patients with acute hepatitis C should consult their healthcare providers if symptoms do not subside after two to three months.
  • Hepatitis D: Anyone who has chronic hepatitis B is also susceptible to infection with another strain of viral hepatitis known as hepatitis D (formerly called delta virus). Hepatitis D virus can only infect cells if the hepatitis B virus (HBV) is present. Injection drug users with hepatitis B have the greatest risk of developing the infection. Individuals who are infected with both HBV and hepatitis D are more likely to develop cirrhosis or liver cancer than patients who only have HBV.
  • Hepatitis E: Hepatitis E is uncommon in the United States. This disease is primarily spread through food or water that is contaminated by feces from an infected person. There is no vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Hepatitis E usually resolves without treatment, within several weeks to months.

Transmission
  • General: HBV is transmitted via bodily fluids. Individuals become infected once an infected person's bodily fluids, including, blood, semen, vaginal secretions or saliva enter their body. Sharing toothbrushes or nail clippers, for instance, can increase the chance of acquiring the infection.
  • HBV is not spread through casual contact, such as hugging or shaking hands. Also, the virus is not spread through sweat or tears.
  • Individuals who are 18 years and younger, and adults who have an increased risk of developing HBV should be vaccinated.
  • Sexual transmission: Individuals who engage in unprotected sex, including vaginal anal or oral sex, with an infected partner may acquire hepatitis B. The infection may also be transmitted if sexual devices are shared and not sterilized or covered with a condom.
  • Needle sharing: HBV can be transmitted through needles and syringes that are contaminated with infected blood. Therefore, individuals who share intravenous (IV) drug paraphernalia have an increased risk of developing the infection.
  • Accidental needle sticks: Healthcare workers and anyone who comes into contact with human blood is at risk of acquiring HBV.
  • Pregnancy: Pregnant women who are infected with HBV can pass the virus to their babies. When the virus is transmitted from mother to fetus, it is called vertical transmission. Therefore, it is recommended that newborn babies of HBV positive mothers receive hepatitis B immune globulin (HBIG), as well as the hepatitis vaccine, which includes a series of three injections. The vaccine will greatly reduce the baby's risk of acquiring the virus.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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