The Facts About Hepatitis

The medical definition of hepatitis is inflammation of the liver. However, this inflammation, or swelling of the tissues, is caused by a variety of infectious viruses and noninfectious agents.

There are five main strains of the hepatitis virus: types A, B, C, D and E. All types can cause liver disease, but each differs in severity and transmission. Most notably, hepatitis B and C lead to chronic disease in millions of people throughout the world and are the most common cause of liver cancer, liver cirrhosis and viral hepatitis-related fatalities.

Millions of people are living with viral hepatitis, but the majority don't realize it, according to the World Health Organization (WHO). An estimated 2.4 million people, or more, are living with hepatitis C in the United States and it's believed that about 850,000 Americans have hepatitis B. People with hepatitis are at risk of unknowingly spreading the virus to others. Asian Americans and Pacific Islanders are most heavily affected by hepatitis B. Asian Americans and Pacific Islanders make up about 5 percent of the U.S. population, but represent approximately half of all individuals living with hepatitis B, according to the U.S. Department of Health and Human Services.

On the flip side, hepatitis D and E are uncommon in the U.S., according to the Centers for Disease Control and Prevention (CDC). Most cases that do occur are among people who migrate or travel to the U.S., or conversely, Americans who visit countries where the conditions are endemic. Hepatitis D and E are rare, and because there is no requirement to notify authorities if you have the conditions, the actual number of people living with hepatitis D and E in the U.S. is unknown.

Overview

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). HAV can be transmitted when someone eats, drinks or consumes something that has been tainted via direct contact with an infected person. This transmission may occur when an infected person prepares food with unwashed hands, during close personal contact such as sexual intercourse, or when providing care for a sick person.

Hepatitis A virus can cause minor illnesses that last a few weeks to severe illnesses that last months. While HAV is very contagious, it does not result in chronic liver disease like hepatitis B and C do.

Most people who contract hepatitis A fully recover with lifelong immunity.

How it's spread

HAV is found in the stool and blood of people who are infected, and it's spread when someone ingests the virus through the following methods:

• Consuming contaminated food or beverage. Contamination of food with HAV can occur at any point, such as growing, harvesting, processing, handling and cooking. Contamination of food and water occurs more commonly in countries where hepatitis A is common. While uncommon, foodborne outbreaks have happened in the U.S. from people eating contaminated food products that were imported.
• Person-to-person contact. Hepatitis A can be spread from close contact with an infected person, such as certain types of sexual contact, caring for someone who is sick or using/sharing drugs with others.

Symptoms

Hepatitis A symptoms usually appear a few weeks after you contract the virus. While there's a chance you may not develop any symptoms, here are some to look out for:

• Abdominal pain
• Dark urine
• Fatigue and weakness
• Gray-colored feces
• Intense itching
• Joint pain
• Loss of appetite
• Low-grade fever
• Sudden nausea and diarrhea
• Jaundice (yellowing of the skin and eyes)

Complications

Hepatitis A does not cause chronic liver damage and does not become a long-term infection.

However, in some rare cases, it can cause a sudden loss of liver function, which typically requires a hospital stay for monitoring and treatment. Some people with acute liver failure may require a liver transplant.

Diagnosing and testing

Hepatitis A is diagnosed based on symptoms and a blood test. The blood test can detect immunoglobulin M (IgM) antibodies, which indicate whether a patient has acute hepatitis A.

If the blood test finds antibodies to the hepatitis A virus that are not IgM antibodies, the patient is immune to hepatitis A, due to either past infection or vaccination.

Treatments

If you believe you have been exposed to hepatitis A, see a doctor immediately. Getting a vaccine could prevent you from getting sick.

For the vaccine to be effective, you need to get it promptly after coming into contact with the virus. There's no treatment once you have been infected. You have to wait it out as your body gets rid of the virus. For most people, their liver is fully healed within six months.

Long-term effects

Immunizations against hepatitis A are safe and effective, though they may cause side effects such as localized pain and swelling at the injection site, fever and headache.

Overview

Hepatitis B is a severe liver infection brought on by the hepatitis B virus (HBV). Hepatitis B is often short term (acute), lasting less than six months for most people. However, some people develop a persistent infection, or chronic hepatitis B, which can last longer than six months.

You run a greater chance of experiencing cirrhosis—a disorder that permanently scars the liver—liver cancer and liver failure if you have chronic hepatitis B.

Even though symptoms are severe, people with hepatitis B typically fully recover. Chronic infections are more likely to occur in infants and young children. Hepatitis B can be prevented with a vaccine but cannot be cured if contracted. Taking precautions can help stop the spread of infection.

How it's spread

HBV is spread through activities that involve a puncture through the skin, or infectious blood or bodily fluids, such as:

• Contact with blood from someone who has an infection
• Exposure to needlesticks
• Being born to someone who has HBV infection
• Having sex with someone who has HBV infection
• Injection drug use that involves sharing needles
• Sharing items with a person who has an infection that can break the skin (e.g., razors) and possibly result in exposure to blood

Symptoms

Symptoms of acute hepatitis B—which range from mild to severe—typically appear one to four months after infection, but some people may not have any symptoms at all.

Common signs and symptoms include:

• Abdominal pain
• Dark urine
• Fever
• Jaundice (yellowing of the skin and eyes)
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue

Complications

Serious medical issues can result from hepatitis B, although your likelihood of developing problems can be decreased by early diagnosis and treatment.

Acute liver failure due to acute hepatitis B is extremely uncommon. A liver transplant may be necessary for people who experience acute liver failure.

Chronic hepatitis B can lead to:

• Cirrhosis of the liver
• Liver cancer
• Liver failure

Diagnosing and testing

Tests that aid a hepatitis B diagnosis include:

• Biopsy. A biopsy involves taking a small sample of the liver and testing it for liver damage. The doctor inserts a thin needle through the skin and into your liver and removes liver tissue for laboratory analysis.
• Blood tests. Testing blood can detect signs of the hepatitis B virus and indicate to your doctor whether the infection is acute or chronic.
• Ultrasound. An ultrasound of the liver can also indicate the amount of damage done.

Treatments

Medications can help control the hepatitis B virus, reducing the risk of developing more serious liver disease. However, there is no cure for hepatitis B.

Treatments for hepatitis B fall into two primary categories:

• Antiviral drugs. These medications help stop or slow the virus from reproducing, decreasing inflammation and damage to the liver. They are taken as a pill daily for at least a year.
• Immune modulator drugs. This type of drug boosts the immune system to help get rid of the virus. They are given as a shot over the course of six months to a year.

Long-term effects

Most people do not suffer long-term issues after being infected with hepatitis B. However, if left untreated, chronic hepatitis B can cause cirrhosis of the liver and increase the risk of liver cancer. It is critical to take any medications prescribed by your doctor and attend checkups to ensure your liver is functioning properly.

Overview

Hepatitis C, caused by the hepatitis C virus (HCV), is a liver infection whose effects can range from mild to severe. Hepatitis C is often described as "acute" or "chronic." Acute hepatitis Coccurs within the first six months of exposure to the virus.

Hepatitis C can be short-lasting, but for many people, acute infection eventually leads to chronic infection. If left untreated, chronic hepatitis Cbecomes a lifelong infection and can cause severe health problems, such as liver damage, liver cancer, cirrhosis of the liver and death.

How it's spread

HCV is most commonly transmitted through:

• Inadequate sterilization of medical equipment, particularly syringes
• Sharing needles during drug use
• The transfusion of unscreened blood

HCV can be passed from an infected mother to her infant and spread through sexual practices that lead to any exposure to blood. The virus is not spread through food, water, breast milk or casual contact, such as kissing, hugging or sharing beverages with an infected person.

Symptoms

Most people infected with HCV do not exhibit any symptoms. Some people's skin may become yellow with time, a sign that they are suffering from jaundice. People with a chronic infection frequently do not exhibit any symptoms until their liver becomes scarred (cirrhosis).

Hepatitis C symptoms may include:

• Abdominal swelling
• Clay-colored stools
• Dark urine
• Fatigue
• Fever
• Itching
• Jaundice
• Loss of appetite
• Nausea
• Pain in the abdomen

Complications

Hepatitis C can cause cirrhosis, liver failure and liver cancer if left untreated.

Cirrhosis causes the liver to steadily deteriorate and become dysfunctional. If you have this disease, your healthy liver tissue is replaced by scar tissue, which partially obstructs blood flow through the liver. The liver still functions in the early stages of cirrhosis, but when the disease advances, your liver begins to fail.

Liver failure progresses over time and is also known as end-stage liver disease. This condition means the liver can no longer perform vital functions or replace damaged cells.

Liver cancer risk is increased by having chronic hepatitis C. Even after receiving hepatitis C treatment, your risk of developing liver cancer remains elevated if persistent hepatitis C results in significant liver damage. To screen for cancer, your doctor can advise blood tests and an ultrasound.

These consequences can be avoided with early hepatitis C testing, diagnosis and treatment.

Diagnosing and testing

To determine if a person has ever had hepatitis C, a blood test known as an HCV antibody test is performed. This test looks for antibodies, which are proteins that are released into the bloodstream after a person contracts the virus.

A second HCV RNA test is administered to people who have tested positive for HCV antibodies to determine whether they are still infected.

Treatments

Depending on the disease's stage, hepatitis C requires different treatments. For acute hepatitis C, there is no recommended treatment. Your doctor may advise you to undergo frequent testing to determine whether the infection will resolve on its own.

For chronic hepatitis C, treatment options include antiviral medications and a liver transplant. Direct-acting antiviral drugs can clear the virus from the body, and these drugs are typically taken for eight to 12 weeks.

Your doctor might advise a liver transplant if you experience severe side effects from chronic hepatitis C infection. However, hepatitis C is not cured by liver transplantation, and if the infection recurs, antiviral medications need to be used to eliminate the virus and protect the new liver.

Long-term effects

Long-term effects of untreated hepatitis C include cirrhosis and liver cancer.

The hepatitis C infection damages the liver cells, which are replaced by scar tissue, and this scarring of the liver is known as cirrhosis. People with cirrhosis have a greater risk of developing liver cancer.

Chronic hepatitis C is a major risk factor for liver cancer. Early detection and treatment are key to prevention. However, the amount of damage to your liver can affect the type of treatment you receive for liver cancer. If you are diagnosed with liver cancer, your healthcare provider may run a series of blood tests to gauge liver function, as well as your blood-clotting ability.

If your liver is too damaged and fails to function, you may be unable to undergo surgery to treat the cancer.

Can hepatitis be cured?

Viral infections often clear up on their own. If the condition becomes chronic, there is no cure for hepatitis B. Medications, especially direct-acting antivirals, are able to cure hepatitis C in most cases, but can be cost-prohibitive to many people.

Hepatitis A and E resolve on their own and don't result in chronic illness.

What are the symptoms of hepatitis?

Some people with hepatitis don't show symptoms and, thus, may not realize they have been infected. If you do have symptoms, they may include:

• Abdominal pain
• Clay-colored stools
• Dark urine
• Fever
• Jaundice, yellowing of skin and eyes
• Loss of appetite
• Low energy
• Nausea and vomiting
• Pain in the joints

What is the main cause of hepatitis?

The most common cause of hepatitis across the globe is viral hepatitis, which consists of hepatitis A, B, C, D and E. Each of these is transmitted in different ways. Other causes of hepatitis include autoimmune diseases and alcohol or drug abuse.