What is Hepatitis?
Hepatitis is an inflammation of the liver. There are five types of hepatitis usually caused by a group of viruses, A through E. Hepatitis can also be caused by other viral infections, such as cytomegalovirus infection, infectious mononucleosis, and yellow fever. Nonviral causes of hepatitis include drugs and alcohol. Hepatitis can be chronic and long-lasting, or acute, which is newly acquired and usually lasts less than 6 months.
Type A hepatitis (HAV) is contracted through anal-oral contact, when a person eats or drinks something contaminated with the feces or blood of someone with hepatitis A. HAV reproduces in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the beginning of clinical illness.
An infected person with poor personal hygiene can contaminate food or water sources. Transmission can occur during sexual contact, especially oral-anal contact. One can also be infected by consuming contaminated raw shellfish.
HAV infection does not result in chronic infection or chronic liver disease. Acute liver failure is rare, and usually occurs in older people. Approximately 33% of the U.S. population has serologic evidence of prior HAV infection. This percentage goes up to 75% in individuals over 70 years old. About 50% of those with HAV cannot identify the source of infection.
Type B hepatitis (HBV) is transmitted through direct contact with infected blood, seminal fluid, vaginal secretions, saliva, and contaminated needles used for drugs, tattooing, or body-piercing. Mothers can infect their infants at birth.
HBV can be acute or chronic. It is estimated that 1.25 million people in the United States are chronically infected with HBV and are at increased risk for death from chronic liver disease.
Type C hepatitis (HCV) is the most common chronic bloodborne infection in the United States, infecting an estimated 2.7 million persons chronically. HCV is usually contracted through blood, blood products, or contaminated needles used for drugs, tattooing, or body-piercing. Blood products used for transfusions and donor organs before 1992 could have been contaminated with HCV. HCV can be transmitted to a baby from an infected mother. 20% of infections are sexually transmitted, vaginally or anally, through vaginal secretions and semen, especially during situations where blood is present.
75% to 85% of those infected, end up with a chronic (lasting more than 6 months) case of HCV. 70% of those infected will have chronic liver disease including such conditions as cirrhosis (scarring of the liver), liver failure, liver cancer, and even death. Hepatitis C is the leading cause of liver transplants. It is estimated that complications from HCV cause 10,000 American deaths annually.
Type D hepatitis (HDV) occurs as a co-infection with hepatitis B, especially chronic HBV. Hepatitis D is usually transmitted through contact with contaminated blood and needles. HDV infects 5% of people with HBV that’s about 15 million people worldwide.
Type E hepatitis (HEV) is most commonly transmitted in feces, through oral contact, or contaminated water. Hepatitis E is extremely rare in the USA, being more common in areas lacking sanitation. HEV usually occurs in persons who travel to or live in an area lacking clean water or sanitation. One can also be infected by consuming contaminated raw shellfish. Hepatitis E occurs primarily in adults. HEV infections do not occur chronically.
Symptoms
Symptoms may not be obvious, but they are similar for all types. Symptoms may include flu-like symptoms, fatigue, loss of appetite, nausea, generalized itching, fever, light or clay colored stools, dark urine, abdominal swelling, abdominal pain, and jaundice (yellowing of the skin and the whites of the eyes).
Hepatitis A (HAV)
Symptoms usually develop about 4 weeks after infection, but may occur in 15-50 days. 10 to 15% of patients may experience a relapse of symptoms during the 6 months following the initial infection.
Hepatitis B (HBV)
The incubation period from the time of exposure to signs and symptoms is 6 weeks to 6 months. If present, symptoms described above, may also include a rash or arthritis during the early stages. Only 50% of adults with acute HBV infections are symptomatic, and about 1% of cases result in acute liver failure or death. Young patients are at a higher risk of a chronic infection. Compared to 2 to 6% of adults, about 90% of infected infants and 60% of infected children under 5 years old become chronically infected. Other concerns are cirrhosis of the liver and liver cancer.
Hepatitis C (HCV)
It is estimated that each year 25,000 Americans are newly infected with hepatitis C, but only 20% of those infected will experience any symptoms. Many people with chronic HCV have mild to moderate liver damage, after being infected for years without being diagnosed because their symptoms (flu-like symptoms, fatigue, loss of appetite, nausea, malaise, fever, light stools, dark urine, abdominal swelling, and jaundice) are not obvious. If a person develops cirrhosis of the liver, the symptoms may be more obvious. Abnormalities are usually noted in liver enzyme levels for those with chronic HCV.
Hepatitis D (HDV)
Only those with active Hepatitis B can be infected with Hepatitis D. Symptoms are similar to those of acute HBV and may not be noticeable or may be severe. HDV may cause symptoms in hepatitis B carriers who had no symptoms and may even increase the severity of an acute HBV infection. The acute cases usually subside over 2 to 3 weeks, but the HBV – HDV infection may become chronic and may be contagious at times through out the lifespan of the infected.
Hepatitis E (HEV)
The incubation period ranges from 15 to 60 days. Many are asymptomatic, but symptoms may include fatigue, loss of appetite, nausea, abdominal pain, and fever. Pregnant women, who become infected with HEV, are particularly at risk as case-fatality rates as high as 15%–25% have been reported. Fetal loss is common.
Treatment
Hepatitis A (HAV)Hepatitis A can be prevented with a two-dose vaccine series, given at least six months apart. These vaccines are recommended for high risk persons and include those living or traveling to a country where HAV is prevalent, injecting drug users, those with chronic liver disease, and men who have sex with men. Immune Globulin (IG) can be given before or after exposure to HAV, to help prevent the disease from manifesting.
There is no cure for HAV, but most people, even with a severe case, will recover completely. Rest, avoiding oral-anal sexual contact, and practicing safe sex with condoms are suggested. Also, abstaining from alcohol and medications such as painkillers and sedatives, which may cause liver damage, is recommended. Those with signs of acute liver failure or dehydration, due to nausea and vomiting, may require hospitalization.
Hepatitis B (HBV)
Hepatitis B can be prevented with a three dose vaccine series, which also prevents hepatitis D, which can exist only with hepatitis B. Routinely vaccinating infants has been protocol for years. Anyone can be vaccinated, but it is especially recommended for those at high risk. Considered high risk would include those who live or travel to areas where HBV is prevalent, men who have sex with other men, health care workers, injecting drug users, and sexual partners of chronic carriers of HBV. Barriers/dental dams and condoms should be used to prevent contagion from sexual (oral, anal, vaginal) contact.
HBV infection can be self-limited or chronic. If the condition is chronic, the antiviral agent, interferon, lamivudine (Epivir), or adefovir dipivoxil, are used to treat HBV. A health care provider should be consulted for more information. If the infection is acute, or recently acquired, no specific treatment is recommended; the disease runs its course and usually results with complete recovery. Hepatitis B immune globulin (HBIG) and the HBV vaccine should be administered within 7 days after being exposed to acute HBV to help prevent illness for individuals who haven’t been vaccinated already. HIV-infected persons with HBV infection are more likely to result with a chronic condition. HIV infection may weaken the response to the HBV vaccine and may require additional doses.
Hepatitis C (HCV)
Most people aren’t diagnosed with acute HCV, because of mild symptoms, and go on and clear the virus completely. After exposure, treating with immune globulin is not effective in preventing HCV infection. There is no defined treatment for acute HCV, but alcohol intake may be restricted, and medications should be reviewed to help protect the liver from further harm.
Treating chronic HCV involves using interferon or a combination of interferon and ribavarin for a duration of 6 to 12 months. Your health care provider should be consulted about the treatment, further evaluation to determine the degree of liver damage, and advice on how to prevent spreading the virus. Barriers/dental dams and condoms should be used to prevent contagion from sexual (oral, anal, vaginal) contact. Personal hygiene habits should also be scrutinized to prevent spreading the virus. It may be suggested to get vaccinated against hepatitis A and B; no vaccine for hepatitis C is available.
Hepatitis D (HDV)
Early diagnosis and treatment of hepatitis B infection can help prevent hepatitis D. The hepatitis B vaccine is recommended to prevent HBV, since HDV only accompanies a HBV infection. The treatment is the same as for hepatitis B.
Hepatitis E (HEV)
Most of those infected with HEV have a self-limiting course. The treatment is usually supportive.
Testing
Hepatitis A (HAV)
Three tests, which detect HAV antibodies, are available. Testing will not identify antibodies beyond 6 months following symptoms.
Hepatitis B (HBV)
Testing is available for HBV. HBsAG, Anti-HBs, and Anti-HBc tests detect HBV presence or antibodies in the blood. These tests can also establish whether the hepatitis is acute or chronic and contagious or not. A battery of all three tests may be suggested, so the results are better interpreted. HBV usually takes 3 weeks to 2 months to be detected, so it may take up to 2 months to properly diagnose.
Hepatitis C (HCV)
Once infected, antibodies may develop in 8 to 9 weeks. Most individuals develop antibodies by 6 months, however, it may take up to year. With this in mind, those with negative test results, having been exposed to hepatitis C, may opt for retesting at a later date. The diagnosis of HCV infection can be made by detecting either antibodies to HCV or the presence of HCV with RNA. For routine testing, it is recommended to use the FDA approved blood tests to detect antibodies to HCV. None of the tests can determine if the virus is chronic or acute. Once diagnosed, further testing should be done to determine the degree of liver damage.
Hepatitis D (HDV)
Blood tests are available to detect the HDV antibodies.
Hepatitis E (HEV)
Testing availability is limited, and no blood test is licensed in the United States commercially.
All sex partners should be tested, so they can receive treatment,
and prevent spreading hepatitis to other sexual partners.