Who Is at Risk for Hepatitis?

Hepatitis is an all-encompassing term referring to inflammation of the liver that's typically caused by a viral infection. The most common forms are hepatitis B and C, which are highly prevalent globally and can lead to significant complications, such as fibrosis, cirrhosis and liver cancer.

This article will shed light on the different types of viral hepatitis, including their modes of transmission, common symptoms, diagnosis, treatment and which demographics are at the highest risk.

Types of viral hepatitis

There are five types of hepatitis, ranging from one that can resolve on its own to one with no cure.

Hepatitis A (HAV)

Hepatitis A primarily spreads through contaminated food and water. It can be contracted during sexual activity, particularly through oral-anal contact. Hepatitis A usually resolves on its own, and treatment typically involves rest, hydration and managing symptoms.

Hepatitis B (HBV)

Hepatitis B is considered a sexually transmitted infection (STI) and the most common form of hepatitis. It is transmitted through contact with infected blood and bodily fluids during sexual activity.

The key to managing and preventing hepatitis lies in raising awareness, promoting vaccination, regular screening for high-risk individuals.

Hepatitis B can lead to chronic infection and result in severe liver complications. A vaccine is available for hepatitis B, but once someone is infected, there is no cure. Antiviral medications such as direct-acting antiviral (DAA) drugs may help control the virus for people without the vaccine.

Hepatitis C (HCV)

Hepatitis C is the second most common hepatitis type in the United States. Transmission during sexual activity is possible, though the risk is lower compared to HBV.

Exposure to infected needles is a common mode of transmission. Hepatitis C can lead to chronic infection and severe liver damage. No vaccine is available, and treatment relies on direct-acting antiviral medications, which are typically effective for more than 90 percent of people.

Hepatitis D (HDV)

Hepatitis D only affects individuals with HBV and exacerbates liver damage caused by HBV. Treatment involves managing the underlying HBV infection and using medications to control the HDV.

Hepatitis E (HEV)

This type is caused by the hepatitis E virus (HEV) and is primarily transmitted through contaminated food or water, similar to HAV. In most cases, hepatitis E resolves spontaneously.

In addition to food-borne or sexual transmission, drug use involving contaminated needles is a common mode of transmission for some forms of hepatitis, especially hepatitis C, which is estimated to have infected nearly 2 million people in the U.S.

According to some experts, treating hepatitis C with DAAs typically takes between eight and 12 weeks, and it eliminates the virus in more than 90 percent of patients.

Treating hepatitis

"Treatments vary depending on the strain," said Louis Morledge, M.D., a board-certified internal medicine specialist with Morledge Medical in New York City. "For a patient infected with hepatitis A, there is usually no treatment. For patients with hepatitis B and C, there are antiviral agents that are used. Treatment is recommended for anyone with either acute or chronic hepatitis C, and treatment usually involves eight to 12 weeks of oral therapy."

Some patients can experience natural spontaneous remission—this is acute hepatitis—that can happen regardless of what type of hepatitis virus is contracted. Chronic hepatitis—when liver inflammation persists for at least six months—is more likely to occur with types B and C.

The nature of an HCV infection is asymptomatic, so many people are unaware they are infected.

"Hepatitis C is also a viral infection that causes liver inflammation and is similarly spread through contaminated blood," Morledge said. "The difference is that chronic hepatitis C is usually a 'silent' infection for many years, with the virus damaging the liver intensely before symptoms are detectable.

"Treatment requires weekly injections and oral medications which some patients are unable to take based on other health problems or unacceptable side effects, but new forms of oral treatment have favorable curable rates. Since 50 percent of adults do not know they are infected, annual screenings are encouraged."

Detection and screening

Being screened regularly is recommended for people considered to be high-risk individuals. According to the Centers for Disease Control and Prevention (CDC), some of these include the following:

• The homeless and drug users. Sharing needles and drug paraphernalia increases the risk of HCV transmission.
• Recipients of blood transfusions or organ transplants before 1992. Widespread screening of blood products was implemented in 1992, but the risk of HCV transmission through transfusions or transplants was higher before this period.
• Hemodialysis patients. People receiving long-term hemodialysis for kidney failure may be at increased risk due to potential exposure to contaminated equipment.
• Healthcare workers. Accidental needlestick injuries or exposure to infected blood can put healthcare professionals at risk.
• People with HIV. People who are HIV positive, particularly men who have sex with men (MSM), have a higher risk of HCV coinfection.
• People with a history of incarceration. The prevalence of HCV is higher among incarcerated populations due to risk factors such as drug use and tattooing with nonsterile equipment.
• Children born to HCV-positive mothers. There is a risk of vertical transmission of HCV from mother to child during childbirth.

"In addition, an infected pregnant person can transmit the disease to their newborn during pregnancy and childbirth," Morledge said. "All of these forms of hepatitis can also be transmitted with needles or other medical/dental equipment that is contaminated or unsterile, through unprotected sex, or the use of illegal or street drugs."

Keep in mind that effective DAAs for hepatitis C were only introduced in 2014, which is relatively recent. According to researchers, prior to this, people with chronic hepatitis C were considered to have very poor long-term outcomes, and the introduction of this therapy has been an overwhelming success at eliminating the virus.

Despite this, treatment is still prohibitively expensive for many patients.

Common symptoms of hepatitis

The symptoms of hepatitis can vary depending on the type and whether the infection is acute or chronic. However, some common symptoms may include, but are not limited to the following:

• Fatigue
• Loss of appetite
• Nausea and vomiting
• Jaundice (yellowing of the skin and whites of the eyes)
• Abdominal pain, particularly in the upper right quadrant
• Joint pain
• Low-grade fever
• Dark urine
• Clay-colored stools

If you experience symptoms indicative of hepatitis or have engaged in high-risk activities (such as unsafe sex or exposure to potentially infected drug paraphernalia/needles), do not hesitate to seek professional help. Seeking help is vital to protecting yourself and others.

"The first step when you feel unwell from symptoms or signs of viral hepatitis, like fatigue, abdominal pain, and yellow coloration of the eye and skin, is to go to your primary healthcare provider," said Sara Mesilhy, M.R.C.P., a gastroenterologist and member of the Royal College of Physicians in the United Kingdom. "They can check your full history, perform the examination and request the basic blood tests to check the status of hepatitis and the antibody test."

More blood samples may be necessary later, depending on the results and symptoms, to check for complications and determine if the disease has progressed.

"In some cases, there is a need for a liver biopsy, or tissue sample, in order to determine the extent of the damage and the cause," she said. "Second step, if the hepatitis is severe, consultation with a hepatologist or gastroenterologist—specialists in diseases of the liver—is recommended."

Educating the public about hepatitis

Hepatitis has various modes of transmission. The key to managing and preventing hepatitis lies in raising awareness, promoting vaccination, regular screening for high-risk individuals and ensuring treatments, such as DAAs, are made affordable and available for high-risk patients.