Hepatitis

Hepatitis (hep-uh-TY-tis) is inflammation * of the liver. This inflammation harms liver cells, which are also known as hepatocytes (heh-PAT-oh-sites). Hepatitis may be acute * or chronic * , mild or extremely serious. It has many causes. These include infection with the hepatitis A, B, C, D, or E viruses; infection with other microbes; exposure to toxic chemicals, including alcohol and certain medications; or as a result of an autoimmune * condition.

The liver, a reddish-brown, wedge-shaped organ in the upper abdomen, is the largest internal organ in the body. It has many jobs. It gets rid of harmful substances that enter the body, disposes of old blood cells, produces chemicals to make the blood clot, processes nutrients from food into a form the body can use, stores these nutrients, and makes sure the blood carries the right balance of fat, sugar, and amino (uh-ME-no) acids (the building blocks of proteins) to body cells.

Hepatitis is a general term that means the liver is inflamed. The word derives from hepatos, the Greek term for “liver,” and “itis,” the Latin term for “inflammation.” Many conditions can cause hepatitis. These include:

Hepatitis B and C can become chronic, which means the infection lasts for more than six months, as well. About 75 to 85 percent of people infected with hepatitis C cannot fight off the virus, and it remains in the body, in many cases for decades, while silently damaging the liver. With hepatitis B, the number of people who develop a chronic infection depends on the age at which they were infected. Ninety percent of infected infants, 25 to 50 percent of those infected between the ages of one and five, and 6 to 10 percent who were infected after age five develop chronic hepatitis B.

Because the liver is large and resilient, it usually keeps working well despite being infected. In fact, some people with chronic hepatitis live a normal life span and are unaware they are infected. But after 10, 20, or more years, many people with chronic infections develop serious liver damage that can be fatal, such as cirrhosis * . For instance, 5 to 20 percent of those infected with chronic HCV develop cirrhosis after having had the disease for 20 to 30 years. Some people with chronic hepatitis require a liver transplant * ; indeed, hepatitis C is the leading reason for people needing such a transplant. People who have chronic hepatitis also have a greater-than-normal risk of developing a type of liver cancer * called hepatocellular carcinoma (heh-puh-to-eSEL-yuh-lur kar-suh-NO-muh). People with chronic HBV are especially likely to develop this cancer, which is often deadly. Experts estimate that HBV causes 80 percent of all hepatocellular carcinomas in the world.

News reports periodically discuss hepatitis outbreaks linked to eating at a particular restaurant or attending a particular preschool or daycare center. These outbreaks of what is known as infectious hepatitis are caused by the hepatitis A virus, which is highly contagious * * from an infected person. Putting a contaminated object in the mouth also spreads the virus. This mode of infection, known as the fecal-oral route, occurs when caregivers fail to wash their hands thoroughly after changing a diaper and then prepare or serve food. It may also occur when a child does not wash his or her hands after using the toilet and then handles another child's pacifier, dishes, or eating utensils. When an HAV outbreak affects people who ate at a particular restaurant, it typically starts when an infected food handler fails to wash his or her hands thoroughly after using the bathroom. Hepatitis A can also spread when water supplies are contaminated with sewage or when people eat raw or undercooked shellfish from contaminated waters. Even microscopic amounts of contaminated feces can cause HAV infections.

Once an individual recovers from hepatitis A, he or she no longer carries the virus and cannot infect others.

Good hygiene, including washing hands after using the toilet and before handling food, can prevent hepatitis A.

A vaccination * to prevent hepatitis A is also available. Medical professionals recommend it for all children at the age of one year and for children and adults traveling to developing countries with poor sanitation. The vaccine is also recommended for healthcare workers, men who have sex with men, illegal drug users, people who work in day-care centers and with the developmentally disabled, and people who work with HAV in laboratories.

A preventive measure is also available for people who have already been exposed to the virus. An injection of immune globulin (GLOB-yoo-lin) can often prevent infection. Immune globulin is made from human blood plasma (the liquid portion of blood) taken from people whose plasma contains antibodies to HAV. These antibodies kill the virus. Immune globulin is most effective when given within two weeks of exposure to the virus.

People with chronic hepatitis B and C are virus carriers, and their blood and other body fluids can transmit the virus to others even if they have no symptoms of illness. The most common way in which HBV and HCV spread is through contact with infected blood. In the United States, HCV is most commonly spread when illegal drug users share the needles or other equipment they use to inject these drugs. The Centers for Disease Control and Prevention (CDC) estimates that one-third of illegal injection drug users between the ages of 18 and 30 are infected with chronic hepatitis C, and 70 to 90 percent of current and former injection drug users over age 30 are infected. The CDC attributes the high percentage of infected older users to the fact that needle sharing was especially prevalent in the 1970s and 1980s, before people knew about the risks of blood-borne illnesses. HCV can also spread through sexual contact, but rarely does so, except in individuals with many sex partners.

In contrast, hepatitis B is most commonly spread among adults in the United States through sexual contact. Contact with any body fluid, including blood and semen, can transmit HBV, which is highly contagious. Indeed, HBV is 50 to 100 times more infectious than the human immunodeficiency virus (HIV) that causes AIDS (acquired immunodeficiency syndrome).

HBV and HCV can also spread to healthcare workers who are accidentally stuck with a needle used on an infected patient or to people who receive body piercings or tattoos with improperly sterilized needles. In addition, people who share razors or toothbrushes that may have small amounts of infected blood on them can become infected.

Prior to 1992, when blood banks began widespread screening of donated blood, receiving a transfusion * containing infected blood was the most common source of HBV and HCV infections in the United States. People with the blood-clotting disorder called hemophilia (hemuh-FIL-ee-uh) were at high risk for such infections because of the frequent transfusions they received. Doctors still advise anyone who received a transfusion before 1992 to be tested for HBV and HCV.

Organ transplant recipients who received organs from infected donors were also at high risk until mandatory donor screening began in 1994. But despite these screenings, some organ recipients became infected until more sensitive tests for detecting HBV and HCV were developed and required for organ donors starting in 2013.

Hepatitis B, and more rarely hepatitis C, can also spread from an infected mother to her newborn. But medical professionals stress that these viruses do not spread to others who are simply near an infected person or who even hug an infected individual without touching a body fluid.

The hepatitis B vaccine has been available since 1982 and is 95 percent effective in preventing chronic HBV infection and liver cancer due to HBV. Since 1991, when routine vaccine administration began in the United States, the number of cases of acute HBV infection has declined by about 82 percent. The CDC recommends the vaccine for all newborns, for everyone under age 18, and for adults at high risk. High-risk adults include those who live with an infected person; have multiple sex partners; go to clinics for drug and sexually transmitted disease treatment; use injectable drugs; have a job that involves contact with human blood; undergo kidney dialysis; are in prison; work with developmentally disabled persons; have chronic liver disease; or are men who have sex with men.

Once an adult has been exposed to HBV, immediate treatment with the HBV vaccine (preferably within 24 hours) can prevent infection. In some cases doctors also administer hepatitis B immune globulin (HBIG) for added protection. The standard preventive treatment for babies born to an infected mother is administering HBIG and the hepatitis B vaccine within 12 hours of birth. People who have not been vaccinated can also prevent hepatitis B by avoiding unprotected sex, using condoms, and staying away from illegal intravenous drugs. Doctors also recommend avoiding any contact with other people's blood by not sharing razors, toothbrushes, or any items that might be contaminated with even the slightest amount of blood and by making sure that sterile needles are used for tattoos and piercings. Infected people can help prevent infecting others by securely covering any cuts or wounds they may have and by cleaning any blood spilled on surfaces or clothing, including dried blood, with a disinfecting bleach solution. HBV can survive outside the body for seven days and remains infectious during that time.

There is no vaccine for hepatitis C, and administering immune globulin does not prevent infection after exposure. Preventive measures, like those for hepatitis B, involve avoiding contact with infected blood by not sharing needles, razors, or toothbrushes; using condoms; and not touching spilled blood, including dried blood. HCV can survive for up to three weeks outside the body and remains infectious during that time.

Depending on the virus, the time from infection to the appearance of symptoms can be two weeks to six months. The incubation * period is 15 to 50 days for hepatitis A, 45 to 160 days for hepatitis B, and 14 to 180 days for hepatitis C.

Individuals with acute viral hepatitis may or may not show symptoms. Those with HAV or HCV are more likely to have no symptoms, while those with HBV or HEV are more likely to have severe symptoms. When symptoms exist, they most often include loss of appetite, nausea, vomiting, fatigue, fever, jaundice, darkened urine, abdominal pain, joint pain, and a skin rash. Bowel movements may appear grayish or pale in color.

Chronic hepatitis can cause loss of appetite, tiredness, low-grade fever, and a general sense of “not feeling well” that doctors call malaise (muh-LAZE). Like people with acute hepatitis, those with chronic hepatitis may experience no symptoms, at least until extensive liver damage has occurred.

If the illness causes severe liver damage, additional symptoms can include weakness, weight loss, itchy skin, an enlarged spleen * , fluid in the abdomen, mental confusion, and small, spiderlike red blood vessels showing through the skin. In some cases, cirrhosis can lead to a severe complication called esophageal varices (eh-SAH-fuh-GEE-ul VAR-ihseez), in which reduced blood flow in the liver causes blood to back up into the esophagus * . This backed-up blood can burst veins, and unless the bleeding is stopped with medication or by tying a rubber band around the veins, shock * and death may occur. Varices can also occur in the upper stomach. Another possible complication of cirrhosis is that the liver may lose its ability to remove toxins * from the blood. This can affect brain function and may even lead to coma * .

In many cases, the first hint of hepatitis comes when a routine blood test shows signs of abnormalities in the liver. In other cases, individuals may try to donate blood and be rejected after their blood is tested.

Some individuals go to the doctor because they have one or more symptoms. Doctors will typically ask about the patient's medical history and whether he or she has been exposed to infectious agents or toxins and whether he or she consumes alcohol or any drugs. The physician will also conduct a physical examination, which may include taking the patient's temperature, feeling for swollen glands, and checking for an enlarged spleen or liver.

Doctors use a combination of blood tests to diagnose the presence and type of hepatitis in patients whose physical examination, symptoms, or lifestyle suggest that they may be affected. Blood tests for liver function and liver damage can reveal the presence and extent of liver disease. Other blood tests are used to identify the type and severity of viral hepatitis. For instance, a test for hepatitis A immunoglobinM (IgM) antibodies will reveal whether or not an individual is infected with HAV. IgM is the first chemical the immune system produces in response to exposure to an antigen.

Other blood tests can indicate whether a viral hepatitis infection is acute or chronic, and virus DNA tests reveal the type and amount of hepatitis virus present. Doctors may also order a liver biopsy * or other tests to determine the extent of any liver damage.

Treatment for hepatitis depends on its cause and how sick the patient is.

People with hepatitis A and E usually recover completely without requiring hospitalization or specific medical treatment. Resting at home and drinking plenty of fluids is usually sufficient. Doctors will advise avoiding alcohol and drugs, which can worsen liver inflammation.

There is no specific treatment for acute HBV infection; self-care at home is usually recommended. For chronic HBV, the goal is to minimize the amount of the virus in the body, since current treatments rarely eradicate the infection. Antiviral drugs like tenofovir that suppress viral replication are used for this purpose, sometimes along with alpha interferon * . Doctors monitor the amount of virus present and the progression of liver damage in patients on an ongoing basis so medications can be changed if needed.

Treatment for acute hepatitis C virus if it is diagnosed, is the same as for the chronic form of the disease. This usually consists of a type of alpha interferon called pegylated interferon, along with the antiviral drug ribavirin. However, many infected people refuse to undergo this treatment because it takes up to a year to eradicate HCV; is ineffective in about 40 percent of patients; and requires weekly injections of pegylated interferon, which often produces unpleasant side effects such as depression * , anxiety, extreme fatigue, and anemia * . However, a 2014 study indicated that combining several newer antiviral drugs with ribavirin and/or pegylated interferon eradicated the virus in about 12 weeks for many patients. Additional studies indicated certain combinations were effective in as few as four weeks, offering hope for less-unpleasant treatment regimens for many patients.

In addition, doctors recommend that people with chronic infectious hepatitis live a healthy lifestyle by avoiding alcohol, getting enough sleep, exercising regularly, and eating a nutritious diet. These measures reduce stress on the liver and can prevent or slow the progression of long-term liver disease.

Treating patients with severe complications of hepatitis such as cirrhosis or liver failure may require hospitalization. For many with advanced cirrhosis or liver cancer, the only treatment option may be a liver transplant in which the patient receives a whole liver from a compatible deceased donor or a piece of a live donor's liver (a piece of a healthy liver can regenerate into an entire organ). Liver transplants are successful in many people, but donor livers are in short supply, and many affected people die before a satisfactory one is found. In addition, not all patients meet the transplant requirements. Those with liver cancer that has spread are usually ineligible, and those who have not refrained from drinking alcohol for a period of months or years are also excluded.

Many people with chronic hepatitis have no symptoms until they have been infected for many years and can live fairly normal lives. Even those with symptoms can often work, go to school, and participate in other activities. Some must take time off when symptoms or treatments make them ill.

As with other chronic illnesses, people with hepatitis often struggle with feelings of grief, worry, and isolation. Some feel a stigma because their illness is often associated with drug abuse, even though it can result from other causes. Because most people know little about hepatitis, friends and even family may have unrealistic fears about catching the disease and may avoid the infected person. Counseling for the entire family can sometimes help, and many patients and families find that support groups help them cope with the challenges as well.

See also AIDS and HIV Infection • Alcoholism • Cirrhosis of the Liver • Infection • Jaundice • Viral Infections

* fulminant (FUL-muh-nant) means a sudden and severe worsening of symptoms. Fulminant hepatitis often leads to liver failure and death.

* cirrhosis (sir-O-sis) is a condition that affects the liver, involving long-term inflammation and scarring, which can lead to problems with liver function.

* cancer is a condition characterized by abnormal overgrowth of certain cells, which may be fatal.

* transplant (TRANS-plant) is a procedure in which an organ or tissue from a donor or made artificially replaces a diseased organ or tissue.

* contagious (kon-TAY-jus) means transmittable from one person to another.

* feces (FEE-seez) is the excreted waste from the gastrointestinal tract.

* vaccination (vak-sih-NAYshun), also called immunization, involves administering a drug, usually by injection, to prevent or decrease the intensity of symptoms of a particular disease. The drug contains killed or weakened germs or parts of germs, which spur the body's immune system to produce antibodies that prevent illness if the recipient later encounters the germs.

* transfusion (trans-FYOO-zhun) is a procedure in which blood or certain parts of blood, such as specific cells, are given to someone who needs them due to illness or blood loss.

* incubation (ing-kyoo-BAY-shun) is the period between infection by a germ and when symptoms first appear. Depending on the germ, this period can range from hours to months.

* spleen is an organ in the upper left part of the abdomen that stores and filters blood. As part of the immune system, the spleen also plays a role in fighting infection.

* esophagus (eh-SAH-fuh-gus) is the soft tube that connects the throat and stomach. Food enters the stomach through the esophagus after being swallowed.

* shock, or circulatory shock, is a life-threatening condition that involves inadequate blood flow throughout the body. This can lead to severe organ damage and death unless prompt treatment restores blood flow.

* toxins are poisons that can harm the body.

* coma (KO-ma) is a state of prolonged unconsciousness, like a very deep sleep. A person in a coma cannot be awakened, and cannot move, see, or speak.

* biopsy (BI-op-see) is a medical procedure in which a small amount of body tissue is taken from the body and examined for signs of disease.

* depression (dih-PRESH-un) is a mental state characterized by feelings of extreme sadness, despair, and hopelessness.

* alpha interferon is an injectable drug that strengthens the immune system and inhibits virus replication. The drug is a humanmade version of the natural alpha interferon the body's immune system produces.

* anemia is a serious medical condition that involves fewer than normal red blood cells and, often, accelerated red blood cell destruction. Since a protein called hemoglobin in red blood cells brings oxygen to cells, anemia can result in damage to body tissues and organs from lack of oxygen.