What Is Hepatitis?
Hepatitis is an inflammation of the liver. It can be caused by viruses or other factors, including alcohol abuse, certain medications or physical trauma. Some cases of hepatitis are not a serious threat to health, but the disease can become chronic and can lead to liver failure and death.
There are four major types of viral hepatitis:
- Hepatitis A – The infection caused by the hepatitis A virus is usually mild and does not become chronic. The virus is most commonly spread by food and water contamination, although it can be passed through sexual practices involving oral-anal contact.
- Hepatitis B – The infection caused by the hepatitis B virus (HBV) is most often passed to a sexual partner during sexual intercourse, especially during anal sex. HBV can also be passed through contact with infected blood, such as with shared needles or a needle stick with contaminated blood, or from a mother to her newborn. The infection may be mild, severe acute or chronic.
- Non-A, Non-B – This infection is primarily caused by the Hepatitis C virus (HCV). The infection is usually mild, but is more likely than HBV to lead to chronic liver disease. With new blood donor screening tests, the likelihood of being infected with HCV has diminished. It is now most often contacted through shared needles or an accidental needle stick in a health care setting. However, it can be spread sexually.
- Hepatitis E – This is another type of non-A, non-B hepatitis. The virus is usually found in areas with poor sanitation. It has not been found in the US and is not spread through sexual contact.
- Delta Hepatitis – The hepatitis D virus (HDV) only produces disease when HBV is present. Most cases have occurred in people who are frequently exposed to blood or blood products, such as hemophiliacs, or among drug users sharing contaminated needles.
How Is Hepatitis Spread?
HBV, HCV and HDV are spread in the following ways:
- Through sexual intercourse with a contaminated person without the use of a condom.
- Sharing contaminated needles among users of injected street drugs.
- Needle stick accidents in a health care setting.
- Mother to child transmission of HBV during birth.
- Transfusions of blood or blood products. Until recently blood transfusions were the most frequent cause of hepatitis C. Blood banks in the US now routinely screen donated blood for HBV and HCV. Tests for HBV also screen out HDV. The risk of acquiring hepatitis through a blood transfusion is very low.
- Personal contact with an infected person. It is spread by contact with virus-infected blood or body fluids, usually through cuts and scrapes or semen (sexual intercourse without a condom) or by sharing personal items such as razor or toothbrush.
What Are the Symptoms of Hepatitis?
The most common early symptoms are mild fever, headache, muscle aches, fatigue, loss of appetite, nausea, vomiting or diarrhea. Later symptoms may include dark and foamy urine and pale feces, abdominal pain, and jaundice (yellowing of the skin and the whites of the eyes). However, 40% of those who have been infected with viral hepatitis have no symptoms. When symptoms are present they can range from mild to severe.
Many of those with HBV only develop flu-like symptoms. Some patients with a more severe form of hepatitis B may develop short-term arthritis-like symptoms. Very severe HBV is rare but can be life-threatening. Early signs, including personality changes and agitated behavior, require immediate medical attention.
Some people, who are infected with HBV or HCV but have no symptoms, become chronic carriers. There are an estimated 1.5 million HBV carriers in the US (300 million carriers worldwide.) About 90% of the babies infected at birth with HBV become chronic carriers. At least ? of all HCV carriers, whether or not they had symptoms, go on to develop chronic liver disease.
How Is Hepatitis Diagnosed?
Several blood tests can detect HBV, HCV or HDV even before symptoms develop. A number of blood tests can also be performed to determine how well the liver is functioning.
How Is Hepatitis Treated?
The acute symptoms of viral hepatitis are usually treated by bed rest, a healthy diet and no alcoholic beverages. Antibiotics are not used to treat hepatitis.
The drug interferon alpha may be used to treat chronic HBV and HCV. Interferon alpha is a genetically engineered form of a naturally occurring protein. The drug improves liver function and may decrease symptoms, although interferon alpha has its own side effects, such as headache, fever and flu-like symptoms. Not all patients respond to interferon alpha. For other patients the benefits may decrease over time.
How Does Hepatitis Affect Pregnant Women?
HBV can be transmitted during childbirth. It is recommended that pregnant women receive a blood test to see if they are a chronic carrier of HBV. If a woman tests positive for HBV, the baby can receive hepatitis B immune globulin and a vaccination for HBV immediately after birth. Immune globulin offers temporary protection and the vaccine provides a longer lasting immunity.