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與 B 型肝炎共存 

我會從 B 型肝炎感染痊癒嗎?
大多數剛受感染的健康成年人會毫無困難地痊癒。但嬰兒和幼兒可能無法成功地擺脫這種病毒。

成年人——90% 的健康成年人會擺脫這種病毒,並且毫無困難地痊癒;10% 會演變為慢性 B 型肝炎。
幼兒——多達 50% 的 1-5 歲受感染幼兒會演變為慢性 B 型肝炎感染。
嬰兒——90% 會演變為慢性感染;只有 10% 能擺脫這種病毒。


「急性」和「慢性」B 型肝炎感染有什麼區別?
接觸病毒後最初 6 個月期間的 B 型肝炎感染被認為是「急性」感染。這是從 B 型肝炎感染痊癒的平均時間。

6 個月後,如果您 B 型肝炎病毒檢驗結果仍然呈陽性 (HBsAg+),則您被認為患有「慢性」B 型肝炎感染,可以持續一生。


如果我患有急性 B 型肝炎,我會生病嗎?
B 型肝炎被認為是一種「無聲的感染」,因為通常不會引起任何症狀。大多數人感到健康而且不知道自己已受感染,這表示他們會在不知情的情況下將病毒傳給他人。其他人可能有輕微症狀,比如誤以為由流感導致的發燒、疲勞、關節或肌肉疼痛,或者食慾減退。

不常見但更嚴重的症狀包括嚴重噁心和嘔吐,眼睛和皮膚發黃(稱為「黃疸」)和胃脹——這些症狀需要立即就醫,患者可能需要住院。


我如何知道我已經從「急性」B 型肝炎感染痊癒?
一旦您的醫生透過驗血已確認您的體內已擺脫這種病毒,並產生保護性抗體 (HBsAb+),您就會免於任何未來的 B 型肝炎感染,並且對其他人不再有傳染性。


如果我被診斷出患有慢性 B 型肝炎,我應該怎麼辦?
如果您的 B 型肝炎病毒檢驗結果呈陽性超過 6 個月,這表明您患有慢性 B 型肝炎感染。您應該與肝病專家、胃腸科醫師或熟悉 B 型肝炎的家庭醫生預約。醫生會為您驗血,可能還會為您做肝臟超音波檢查,以評估 B 型肝炎病毒在您體內的活躍程度,並觀察您的肝臟健康情況。您的醫生很可能希望每年至少見到您一次或兩次,以監測您的 B 型肝炎,並確定您是否會從治療中改善。

所有慢性感染者無論是否開始治療,都應該至少每年看一次(或更頻繁地)醫生,進行定期的醫療追蹤。即使病毒處於較不活躍的階段,肝臟極少或沒有發生任何損傷,但這會隨時間發生改變,這也正是定期追蹤如此重要的原因。

大多數慢性 B 型肝炎感染者都有望活得健康長久。一旦您被診斷為慢性 B 型肝炎,病毒可能在您的血液和肝臟中終生停留。重要的是要知道,您可能將病毒傳給他人,即使您並不覺得不舒服。所以確保所有親密的家人和性伴侶都接種 B 型肝炎疫苗是很重的。

哪些檢查會用來監測我的 B 型肝炎?
醫生用來監測 B 型肝炎的常見檢查包括 B 型肝炎血檢、肝功能檢驗 (ALT、AST)、B 型肝炎病毒 e 抗原 (HBeAg)、B 型肝炎 e 抗體 (HBeAb)、B 型肝炎 DNA 定量(病毒載量)和肝臟造影研究(超音波、FibroScan [暫態彈性造影] 或 CT 掃描)。


慢性 B 型肝炎有治癒的方法嗎?
慢性 B 型肝炎目前還沒有治癒的方法,但好消息是,有一些治療方法可以藉由減緩病毒擴散的速度來幫助減緩慢性感染者肝病的進展。如果產生的 B 型肝炎病毒較少,那麼對肝臟的損傷就比較小。有時這些藥物甚至可以擺脫這種病毒,儘管並不常見。

隨著令人振奮的新研究,相信找到慢性 B 型肝炎的治癒方法指日可待。請參閱我們的 Drug Watch,瞭解目前正在研發中的其他具有潛力的藥物。


有任何已批准的藥物來治療慢性 B 型肝炎嗎?
目前針對 B 型肝炎的治療分為兩種一般類別:抗病毒藥物和免疫調節劑:
抗病毒藥物——這些藥物可以減緩或阻止 B 型肝炎病毒,進而減少肝臟發炎和造成的損害。這些藥物為丸劑,每天服用一次,療程至少 1 年,通常更久

目前有六種經美國食品和藥物管理局 (FDA) 批准的抗病毒藥物,但是只有三種一線抗病毒藥物是獲得推薦的治療方法:惠立妥(tenofovir disoproxil,商品名 Viread/TDF)、韋立得(tenofovir alafenamide,商品名 Vemlidy/TAF)和貝樂克(entecavir,商品名 Baraclude)。推薦使用一線抗病毒藥物,因為他們更安全也最有效。他們的抗藥性比舊的抗病毒藥物更好,這表示按處方服用時,發生突變和抗藥性的可能性更小。抗藥性增加使得治療和控制病毒更加困難。

免疫調節藥——這些藥物可以增強免疫系統,以幫助控制 B 型肝炎病毒。他們在 6 個月到 1 年的時間裡以注射方式給藥。最常見的處方藥物包括干擾素 alfa-2b (Intron A) 和聚 B 二醇干擾素 (Pegasys)。這是針對同時感染肝炎三角區的患者唯一的推薦治療方法。

這些藥物能為慢性 B 型肝炎提供「治癒的方法」嗎?

雖然他們無法徹底治癒這種病,但目前的藥物會減緩病毒擴散的速度,並降低日後患上更嚴重肝病的風險。患者在幾個月以內會有所改善,這是因為病毒對肝臟的損傷減緩,或者在某些情況下,甚至在長期服用後出現逆轉。抗病毒藥物不能隨意停止和開始,這就是在開始治療慢性 B 型肝炎病毒之前需要由專業醫生進行徹底評估的原因。


如果我患有慢性 B 型肝炎感染,我應該服用藥物嗎?
重要的是要瞭解,並非每個慢性 B 型肝炎患者都需要服藥。您應該與您的醫生討論您是否適合藥物療法。無論您和您的醫生決定您是否應該開始治療,您都應該定期去肝臟專科醫生或精通 B 型肝炎治療的醫生處就診。


若患有 B 型肝炎感染,服用草藥或補充劑安全嗎?
許多人都有興趣使用草藥或補充劑來增強他們的免疫系統和幫助他們的肝臟。問題在於,生產這些產品的公司並沒有被監管,這表示沒有嚴格的安全或純度檢測。因此,各類草藥或維他命補充劑的產品品質可能不同。另外,有些草藥可能會干擾治療 B 型肝炎或其他病症的處方藥;有些甚至會傷害您的肝臟。這些草藥不會治癒慢性 B 型肝炎。

有許多公司在網路上或者透過社交媒體對他們的產品做誇大不實的廣告。網路上臉書上的宣傳和患者感言可能是假的,用來欺騙人們購買昂貴的草藥和補充劑。記住,如果好得令人難以置信,那麼很可能不是真的。

以下是關於藥草和替代藥物的可靠資訊來源。這些資訊基於科學證據,不是以訛傳訛。檢查您的草藥或補充劑中的有效成分是否是真的,而且對您的肝臟是安全的。最重要的是要保護您的肝臟免受任何額外的損害。


對於那些慢性 B 型肝炎患者,有哪些健康的提示?
慢性 B 型肝炎感染患者可能或可能不需要藥物治療。但是,患者可以做很多其他的事情來保護他們的肝臟和增進他們的健康。以下是我們今天可以開始的十大健康選擇的清單!

  • 安排定期到您的肝臟專科醫生或醫護人員處就診,以掌握您的健康和肝臟的健康情況。
  • 接種 A 型肝炎疫苗,以保護自己遠離對肝臟有害的其他病毒。
  • 避免飲酒和抽菸,因為兩者都會傷害肝臟。
  • 在開始服用任何草藥或維他命補充劑之前,先與您的醫生討論,因為有些藥物可能會干擾您的 B 型肝炎處方藥物,甚至會損害您的肝臟。
  • 向您的藥劑師諮詢任何非處方藥(如:對 B 醯氨基酚、撲熱息痛)或非 B 型肝炎處方藥,之後再服用這些藥物,以確保他們對您的肝臟是安全的,因為很多這些藥物都是經過肝臟處理的。 
  • 避免吸入油漆、油漆稀釋劑、膠水、家用清潔產品、去光水以及其他可能損害肝臟的有毒化學物質的氣味。 
  • 健康飲食,食用水果、全穀類、魚類和瘦肉以及大量蔬菜。尤其是「十字花科蔬菜」,如包心菜、青花菜、花椰菜等,已被證明有助於保護肝臟對抗環境中的化學物質。 
  • 避免食用生的或未煮熟的貝類(如蛤蚌、貽貝、牡蠣、扇貝),因為他們可能會被一種叫做創傷弧菌的細菌污染,這種細菌對肝臟非常有害,可能造成嚴重損傷。
  • 檢查堅果、玉蜀黍、玉米、花生、高粱和小米有無發霉跡象。如果食物儲存在潮濕的環境中,沒有妥善密封,那麼黴菌則更有可能是個問題。如果有黴菌,那麼這些食物可能會被「黃麴黴毒素」污染,這是肝癌的已知風險因素。
  • 藉著吃健康的食物、規律運動和獲得充分的休息來減輕壓力。 
  • 記住您吃的、喝的、呼吸的或透過皮膚吸收的每樣東西最終都要由肝臟來過濾。所以,請保護您的肝臟和您的健康!


如果我有 B 型肝炎,我可以捐血嗎?
不能。即使您已經從急性感染痊癒,血庫也不會接受任何已接觸過 B 型肝炎的血液。

 

Living with Hepatitis B 

Will I recover from a hepatitis B infection?
Most healthy adults who are newly infected will recover without any problems. But babies and young children may not be able to successfully get rid of the virus.

  • Adults – 90% of healthy adults will get rid of the virus and recover without any problems; 10% will develop chronic hepatitis B. 
  • Young Children – Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection.
  • Infants – 90% will become chronically infected; only 10% will be able to get rid of the virus. 

 

What is the difference between an "acute" and a "chronic" hepatitis B infection?
A hepatitis B infection is considered to be “acute” during the first 6 months after being exposed to the virus. This is the average amount of time it takes to recover from a hepatitis B infection.
If you still test positive for the hepatitis B virus (HBsAg+) after 6 months, you are considered to have a "chronic" hepatitis B infection, which can last a lifetime.


Will I become sick if I have acute hepatitis B?
Hepatitis B is considered a "silent infection” because it often does not cause any symptoms. Most people feel healthy and do not know they have been infected, which means they can unknowingly pass the virus on to others. Other people may have mild symptoms such as fever, fatigue, joint or muscle pain, or loss of appetite that are mistaken for the flu.

Less common but more serious symptoms include severe nausea and vomiting, yellow eyes and skin (called “jaundice”), and a swollen stomach - these symptoms require immediate medical attention and a person may need to be hospitalized.


How will I know when I have recovered from an "acute" hepatitis B infection?
Once your doctor has confirmed through a blood test that you have gotten rid of the virus from your body and developed the protective antibodies (HBsAb+), you will be protected from any future hepatitis B infection and are no longer contagious to others.
What should I do if I am diagnosed with chronic hepatitis B?
If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection.

You should make an appointment with a hepatologist (liver specialist), gastroenterologist, or family doctor who is familiar with hepatitis B. The doctor will order blood tests and possibly a liver ultrasound to evaluate how active the hepatitis B virus is in your body, and to monitor the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment.
All chronically infected people should be seen by their doctor at least once a year (or more frequently) for regular medical follow-up care, whether they start treatment or not. Even if the virus is in a less active phase with little or no damage occurring, this can change with time, which is why regular monitoring is so important.

Most people chronically infected with hepatitis B can expect to live long, healthy lives. Once you are diagnosed with chronic hepatitis B, the virus may stay in your blood and liver for a lifetime. It is important to know that you can pass the virus along to others, even if you don’t feel sick. This is why it’s so important that you make sure that all close household contacts and sex partners are vaccinated against hepatitis B.

What tests will be used to monitor my hepatitis B?
Common tests used by doctors to monitor your hepatitis B include the hepatitis B blood panel, liver function tests (ALT, AST), hepatitis B e-Antigen (HBeAg), hepatitis B e-Antibody (HBeAb), hepatitis B DNA quantification (viral load), and an imaging study of the liver (ultrasound, FibroScan [Transient Elastography] or CT scan).


Is there a cure for chronic hepatitis B?
Right now, there is no cure for chronic hepatitis B, but the good news is there are treatments that can help slow the progression of liver disease in chronically infected persons by slowing down the virus. If there is less hepatitis B virus being produced, then there is less damage being done to the liver. Sometimes these drugs can even get rid of the virus, although this is not common.

With all of the new exciting research, there is great hope that a cure will be found for chronic hepatitis B in the near future. Visit our Drug Watch for a list of other promising drugs in development.

Are there any approved drugs to treat chronic hepatitis B?
Current treatments for hepatitis B fall into two general categories, antivirals and immune modulators:

Antiviral Drugs - These are drugs that slow down or stop the hepatitis B virus, which reduces the inflammation and damage to the liver. These are taken as a pill once a day for at least 1 year, usually longer. There are 6 U.S. FDA approved antivirals, but only three first-line antivirals are recommended treatments: tenofovir disoproxil (Viread/TDF), tenofovir alafenamide (Vemlidy/TAF) and Entecavir (Baraclude). First-line antivirals are recommended because they are safer and most effective. They also have a better resistance profile than older antivirals, which means that when they are taken as prescribed, there is less chance of mutation and resistance. Building resistance makes it harder to treat and control the virus.

Immunomodulator Drugs - These are drugs that boost the immune system to help control the hepatitis B virus. They are given as injections over 6 months to 1 year. The most commonly prescribed include interferon alfa-2b (Intron A) and pegylated interferon (Pegasys). This is the only recommended treatment for patients coinfected with hepatitis delta.

Do these drugs provide a “cure” for chronic hepatitis B?

Although they do not provide a complete cure, current medications will slow down the virus and decrease the risk of more serious liver disease later in life. This results in patients feeling better within a few months because liver damage from the virus is slowed down, or even reversed in some cases, when taken long-term. Antivirals are not meant to be stopped and started, which is why a thorough evaluation by a knowledgeable doctor is so important before beginning treatment for chronic HBV.


If I have a chronic hepatitis B infection, should I be on medication?
It is important to understand that not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy. Whether you and your doctor decide you should start treatment or not, you should be seen regularly by a liver specialist or a doctor knowledgeable about hepatitis B.


Is it safe to take herbal remedies or supplements for my hepatitis B infection?
Many people are interested in using herbal remedies or supplements to boost their immune systems and help their livers. The problem is that there is no regulation of companies manufacturing these produces, which means there is no rigorous testing for safety or purity. So, the quality of the herbal remedy or vitamin supplement may be different from bottle to bottle. Also, some herbal remedies could interfere with your prescription drugs for hepatitis B or other conditions; some can even actually damage your liver. These herbal remedies will not cure a chronic hepatitis B infection.

There are many companies that make false promises on the Internet and through social media about their products. Online claims and patient testimonials on Facebook are fake and are used to trick people into buying expensive herbal remedies and supplements. Remember, if it sounds too good to be true, then it’s probably not true.

Below are reliable sources of information about herbs and alternative medicines. This information is based on scientific evidence, not false promises. Check whether the active ingredients in your herbal remedies or supplements are real and safe for your liver. The most important thing is to protect your liver from any additional injury or harm.


What healthy liver tips are there for those living with chronic hepatitis B?
People living with chronic hepatitis B infection may or may not need drug treatment. But there are many other things patients can do to protect their liver and improve their health. Below is our list of the top 10 healthy choices that can be started today!

  • Schedule regular visits with your liver specialist or health care provider to stay on top of your health and the health of your liver.
  • Get the Hepatitis A vaccine to protect yourself from another virus that attacks the liver.
  • Avoid drinking alcohol and smoking since both will hurt your liver, which is already being injured by the hepatitis B virus.
  • Talk to your provider before starting any herbal remedies or vitamin supplements because some could interfere with your prescribed hepatitis B drugs or even damage your liver.
  • Check with your pharmacist about any over-the-counter drugs (e.g. acetaminophen, paracetamol) or non-hepatitis B prescription drugs before taking them to make sure they are safe for your liver since many of these drugs are processed through your liver. 
  • Avoid inhaling fumes from paint, paint thinners, glue, household cleaning products, nail polish removers, and other potentially toxic chemicals that could damage your liver. 
  • Eat a healthy diet of fruit, whole grains, fish and lean meats, and lot of vegetables. “Cruciferous vegetables” in particular -- cabbage, broccoli, cauliflower -- have been shown to help protect the liver against environmental chemicals. 
  • Avoid eating raw or undercooked shellfish (e.g. clams, mussels, oysters, scallops) because they could be contaminated with bacteria called Vibrio vulnificus, which is very toxic to the liver and could cause a lot of damage.
  • Check for signs of mold on nuts, maize, corn, groundnut, sorghum, and millet before using these foods. Mold is more likely to be a problem if food is stored in damp conditions and not properly sealed. If there is mold, then the food could be contaminated by “aflatoxins,” which are a known risk factor for liver cancer.
  • Reduce your stress levels by eating healthy foods, exercising regularly, and getting plenty of rest.

Keep in mind everything you eat, drink, breathe, or absorb through the skin is eventually filtered by the liver. So, protect your liver and your health!


Can I donate blood if I have hepatitis B?
No. The blood bank will not accept any blood that has been exposed to hepatitis B, even if you have recovered from an acute infection.