ABC’s of Hepatitis

What Is Hepatitis?

Inflammation of the liver of any cause is referred to as hepatitis. It may be caused by viruses, drugs, or alcohol, although the most common cause is viruses, viral hepatitis. There are several types of viral hepatitis, the most common of which are hepatitis A, B, and C.

 

Symptoms of Hepatitis

Very frequently the onset of hepatitis, the acute phase, is not associated with symptoms or signs, but when they do occur they are usually general and include fatigue, nausea, decreased appetite, mild fever, or mild abdominal pain. Later signs more specific for liver disease may occur, specifically yellowing of the skin and eyes (jaundice) and darkening of the urine. If the infection becomes chronic as is the cause with hepatitis B and C, that is, lasting longer than months, the symptoms and signs of chronic liver disease may begin. At this point the liver often is badly damaged.

How Is Hepatitis Diagnosed?

Chronic hepatitis slowly attacks the liver over many years without causing symptoms. If the infection is not diagnosed and treated, many people will develop damaged livers. If suspected, viral hepatitis of all types can be diagnosed easily by blood tests.

Hepatitis A

Highlights:

• 1.       Hepatitis A is highly contagious. It usually is spread via a fecal-oral route, meaning via fecal contamination of food.
• 2.       Mild hepatitis without symptoms.
• 3.       The virus is eliminated by the body rapidly, and it does not cause long-term damage.

Prevention:

Washing the hands helps prevent transmission of hepatitis A

Treatment:

No treatment is needed for hepatitis A since the infection almost always resolves on its own. Nausea is common, though transient, and it is important to stay hydrated. It is recommended that strenuous exercise be avoided until the acute illness is over.

Hepatitis B

Highlights:

1.       A majority of adults who contract hepatitis B have none to mild symptoms, and then the virus resolves spontaneously; however, about 5% of people are not able to eliminate the hepatitis B virus and develop chronic infection.

2.       If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life.

3.       This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, and liver cancer.

Prevention:

Can be vaccinated.

Treatment:

For hepatitis B, treatment is aimed at controlling the virus and preventing damage to the liver. Antiviral medications are available that will benefit most people, but the medications need to be chosen carefully, and the treatment needs to be monitored to prevent medication-related side effects.

Hepatitis C

 Highlights:

1.       With acute hepatitis C, the virus is eliminated in 25% of people.

2.       The 75% of the people become chronically infected and later may develop serious complications such as liver failure and liver cancer.

3.   Hepatitis C is transmitted primarily by infected blood, for example by sharing needles when injecting illicit drugs.

4.     It only takes one exposure to hepatitis C to become chronically infected, so people who have injected illegal drugs even one time or many years previously could have chronic hepatitis C, and not know it since there are often no symptoms. People with blood transfusions prior to 1992 - when they started testing blood for transfusion for hepatitis C also may have become chronically infected.

 According to WHO:

1. 15–45% people infected with HCV get better within six months without ever receiving treatment.
2. Many people are unaware they’re infected.
3. 55–85%will develop chronic HCV infection.
4. For people with chronic HCV infection, the chance of developing cirrhosis of the liver is 15–30% within 20 years.
5. 130–150 million people around the world are living with chronic HCV.
6. Treatment with antiviral medications can cure HCV in many cases, but in some parts of the world, access to the necessary medical care is lacking.
7. Antiviral treatment can reduce risk of cirrhosis of the liver and liver cancer.
8. Antiviral treatment works for 50–90% of people treated.
9. 350,000–500,000 people die from HCV-related complications each year.

Treatment:

For Hepatitis C, the drugs currently used (as of March 2016) include pegylated interferon, ribavirin, elbasvir, grazoprevir, ledipasvir 90mg/sofosbuvir 400mg (Harvoni), paritaprevir, ritonavir, ombitasvir, dasabuvir, simeprevir, daclatasvir. These are always used in various combinations, never alone. Interferon is given by injection while the other medications are pills. Studies have shown that combinations of these drugs can cure all but a small proportion of patients; however, serious side effects of treatment can occur.

Treatment options need to be discussed with a knowledgeable physician, as the appropriate combination is dependent upon multiple factors. These include genotype (there are 6), prior treatment and results, drug intolerances, presence of compensated liver disease or uncompensated cirrhosis, presence of HIV co-infection, other complicating conditions and liver transplantation. 

Monitoring Chronic Hepatitis

Monitoring of the progression of liver disease and its treatment are the cornerstones of managing hepatitis B and C. Doctors regularly follow blood tests to determine how well the liver is functioning. Ultrasound examinations and CT scans can determine if there are complications such as cirrhosis or liver cancer that can be treated more effectively if found early.

Complications: Cirrhosis

Cirrhosis is the most common complication of chronic hepatitis. Cirrhosis can be detected with simple tests, but the liver biopsy is the best way to diagnose it. Cirrhosis occurs as the liver is destroyed and it is associated with liver failure, a life-threatening condition. The signs of cirrhosis include retention of fluid (swelling of the abdomen or lower extremities, fatigue, nausea, and weight loss. Later, confusion and jaundice occur due to the accumulation of chemicals normally removed by a healthy liver.

Complications: Liver Cancer

The major cause of liver cancer is hepatitis B and C, and can develop silently as the liver becomes cirrhotic. Blood tests, ultrasound examinations, CT and MRI scans can identify the cancers (seen here in green). Biopsy of the liver is needed to definitely make a diagnosis of cancer. If the cancers are found early, a small proportion of patients can be cured.

Liver Transplant

The liver serves many functions including the manufacture and removal of chemicals that allow cells to function normally, digestion of food, elimination of toxic chemicals, and the production of many proteins that the body needs. Thus, if a large portion of the liver is damaged, the liver cannot perform these critical functions; it is impossible to live without a liver. If the liver fails, a liver transplant may be the only hope, but it is not easy to find a healthy liver to transplant.

Hepatitis A and B Vaccines

Vaccines can protect against hepatitis A and B. The Centers for Disease Control recommends hepatitis A vaccination for children 12 to 23 months of age and for adults who travel or work in locations with a higher prevalence of hepatitis A infection. Vaccination for hepatitis A also should be given to people with hepatitis B and C. If the mother has chronic hepatitis B, the infant should receive the hepatitis B vaccine as well as hepatitis B immune globulin to prevent the development of chronic hepatitis B. There is no vaccine for hepatitis C.

Protecting Your Liver

If you have chronic hepatitis, you should prevent further damage to your liver, for example, by not drinking alcohol. Since some medications and supplements can damage the liver, before taking them you should discuss it with your doctor. Regular appointments for follow-up are important. Early progressions of the disease or complications are likely to change treatment.