You may have heard about Hepatitis, which simply is an inflammatory condition of the liver. Usually, the inflammation is caused by an infection, such as a virus, or it can occur as a result of medications, drugs, too much alcohol, or toxins. The most common forms of viral hepatitis are hepatitis A, B, and C. According to the Centers for Disease Control and Prevention (CDC), 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people carry the virus but don’t know it.
You only have one liver and it is a very busy, essential organ that we typically take for granted until there’s an issue or problem. Here are just a few of the critical jobs your liver is busy taking care of for you. Your liver:
- Filters toxins and helps eliminate them from your body
- Produces bile, which is essential for digestion and metabolism
- Clears bilirubin (a by-product of red blood cells), cholesterol, hormones, and drugs
- Breaks down carbohydrates, fats, and proteins
- Activates enzymes and proteins essential to body functions
- Stores glycogen (a form of sugar) for quick energy
- Stores numerous minerals, Vitamin K and the fat-soluble vitamins (A, D, and E).
- Synthesizes blood proteins, such as albumin
- Synthesizes blood clotting factors
Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is thankfully rare, usually acute but can be particularly dangerous in pregnant women.
Hepatitis A (HAV)
The Hepatitis A virus is most commonly transmitted through water or food that has been contaminated by feces from a person who has hepatitis A. It is very contagious and can spread from person to person in many different settings. Typically, it does not cause severe illness and goes away on its own without harming the liver. There is a vaccine for Hepatitis A, which requires 2 doses at least 6 months apart. It is recommended for anyone traveling to areas where there are high rates of infection, high rates of diarrhea from any cause, and high rates of food contamination.
What Raises Risks for Hep A?
- Eating raw shellfish, fresh vegetables, fruits, and undercooked foods
- Day care centers and nursery schools due to diaper changing combined with lack of good hygiene practices
- Traveling to or living in a country with high infection rates. The CDC posts travel advisories about recent outbreaks in various countries
- Eating raw foods or drinking tap water while traveling abroad
Hepatitis A signs and symptoms
Symptoms typically don’t appear until you’ve had the virus for a few weeks, and not everyone with hepatitis A develops them. Hepatitis signs and symptoms can include:
- Yellowing of the skin and the whites of your eyes (jaundice)
- Sudden nausea and vomiting
- Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
- Loss of appetite
- Low-grade fever
- Itchy skin
Hepatitis B (HBV)
Hepatitis B is transmitted through contact with infected bodily fluids. The virus is not transferred by sneezing, coughing, breastfeeding or kissing – here are ways it is transferred:
- Injection drug use
- Sexual contact with an infected person through blood, vaginal secretions, or semen
- Direct contact with infected or contaminated blood, even in tiny amounts
- Sharing toothbrushes, clippers, razors, syringes, or glucose monitors that have even microscopic amounts of blood on them
- Direct contact with open wounds or fluids of an infected person
- An infected mother passing it to her baby at birth– a new American Academy of Pediatrics (AAP) policy recommends newborns get their first hepatitis B vaccine in their first day of life
The CDC estimates that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease. Many adults who contract hepatitis B have mild symptoms and are able to recover without treatment. But for some this can become a long-term infection which can lead to serious liver problems, including liver cancer.
There is a vaccine for Hepatitis B and requires 3 separate injections. Most health care workers are vaccinated since the risk of exposure to Hepatitis B is so high when working around blood and other body fluids.
Hepatitis C (HCV)
The hepatitis C virus is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection. Facts about Hep C:
- Spreads through blood-to-blood contact or from sexual intercourse
- Chronic hepatitis C can cause serious complications, including liver failure and liver cancer.
- Multiple sex partners and anal sex raises risk
- Tattooing or piercing with an infected needle can transmit the virus
- Often passed when people share needles with drug use
- A mother may pass the virus to her child at birth
Treatment for Hepatitis C
The latest drug to be approved by the FDA is glecaprevir and pibrentasvir (Mavyret). This medication offers a treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.
Common Symptoms of Hepatitis B and C
If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms early on. Symptoms may not occur until the damage affects liver function.
Sometimes there are no symptoms of hepatitis in the first weeks after infection — the acute phase. But when they happen, the symptoms of types A, B, and C may include:
- yellow skin or eyes (jaundice)
- poor appetite
- belly pain
- a mild fever
When hepatitis B and C become chronic, they may cause no symptoms for years. By the time there are any warning signs, the liver may already be damaged.
How Is Hepatitis Diagnosed?
As chronic hepatitis can slowly damage the liver without warning testing is now recommended routinely for people with new sexual partners, during pregnancy and every 5-10 years even for those at low risk is important. Your healthcare provider may perform these tests:
- Lab test to check for the antibodies to Hepatitis B and/or C
- Liver function tests– high liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.
- Ultrasound–this test allows your doctor to take a close at your liver and nearby organs to look for fluid in your abdomen or liver damage or enlargement.
- Liver biopsy–to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal
Managing Chronic HBV and HCV
Regular testing is needed to ensure the liver is not being affected, and to administer medication to protect it. Treatment and monitoring also reduce the risk of passing the infection on to others.
Treatment for chronic hepatitis B and C may include:
Antiviral medications. Several antiviral medications — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera), and telbivudine (Tyzeka) — can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth.
Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It’s used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years after completing this treatment. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing, and depression.
Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. Your liver will be removed and replaced with one from a donor.
Hepatitis D and E – Uncommon in the US
Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs if you already have a hepatitis B infection.
Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV) and is caused by feces contaminating a water supply. Cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC.
Hooray for Vaccines!
The use of vaccines is an essential tool in preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. There is currently no vaccine for hepatitis C. A vaccination for hepatitis E exists in China, but it isn’t available in the United States.
Most children begin the two-vaccine series for hepatitis A between ages 12 and 18 months. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.
Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel and for adults who plan to travel or work in areas with hepatitis outbreaks. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease.
World Hepatitis Day is celebrated every year on July 28, learn more about how this disease is affecting people all over the world at World Hepatitis Alliance.
I hope this helps answer your questions on Hepatitis. If you have chronic Hepatitis B or C, I’d like to know how you manage your condition and prevent the spread to people in your household.