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Hepatitis

Viral hepatitis, including hepatitis A, hepatitis B, and hepatitis C, are a group of distinct diseases that affect the liver. Each have different hepatitis symptoms and treatments. Some causes of hepatitis include recreational drugs and prescription medications. Laboratory tests can determine hepatitis types.

What is Hepatitis?

If your doctor tells you that you’ve got hepatitis, you’ll need to find out which type he’s talking about. There are five kinds, and each has different causes. They share one thing in common: Hepatitis infects your liver and causes it to get inflamed.

What Causes the Different Types?

The type of virus that’s causing your hepatitis affects how severe your disease is and how long it lasts.

Types of Hepatitis: A, B, and C

There are three major types of hepatitis, and all of them affect your liver. Some of the symptoms are similar, but they have different treatments.

Hepatitis A. This type won’t lead to long-term infection and usually doesn’t cause any complications. Your liver heals in about 2 months. You can prevent it with a vaccine.

Hepatitis B. Most people recover from this type in 6 months. Sometimes, though, it causes a long-term infection that could lead to liver damage. Once you’ve got the disease, you can spread the virus even if you don’t feel sick. You won’t catch it if you get a vaccine.

Hepatitis C. Many people with this type don’t have any symptoms. About 80% of those with the disease get a long-term infection. It can sometimes lead to cirrhosis, a scarring of the liver. There’s no vaccine to prevent it.

How do you get Hepatitis A?

You get it from eating or drinking something that’s got the virus in it.

How do you get Hepatitis B?

You can get it if you:

  • Have sex with someone who’s infected
  • Share dirty needles when using illegal drugs
  • Have direct contact with infected blood or the body fluids of someone who’s got the disease

If you’re pregnant and you’ve got hepatitis B, you could give the disease to your unborn child. If you deliver a baby who’s got it, he or she will need to get treatment in the first 12 hours after birth.

How do you get Hepatitis C?

Just like hepatitis B, you can get this type by sharing needles and having contact with infected blood. You can also catch it by having sex with someone who’s infected, but that’s less common.

If you had a blood transfusion before new screening protocols were put in place in 1992, you are at risk for Hepatitis C. If not, the blood used in transfusions today is safe. It gets checked beforehand to make sure it’s free of the virus that causes hepatitis B or C.

Hepatitis Symptoms

It’s possible you might have hepatitis and not realize it at first. Sometimes there aren’t any symptoms. Or you might not get the right diagnosis because the disease shares some of the same signs as the flu.

The most common symptoms of hepatitis are things like:

  • Loss of appetite
  • Fatigue
  • Mild fever
  • Muscle or joint aches
  • Nausea and vomiting
  • Pain in your belly

Some people have other issues, such as:

  • Dark urine
  • Light-colored stools
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Itchy feeling
  • Mental changes, such as stupor (being in a daze) or coma
  • Bleeding inside your body

When to see your doctor

Always check with your doctor if you have any of the signs of hepatitis. If you don’t get treatment, it can lead to cirrhosis, a serious scarring of your liver.

Also make an appointment if a friend or member of your family comes down with the disease. There’s a risk you could get infected, too.

Be on the lookout for symptoms of hepatitis if you travel to a country where the disease is common. Call you doctor if you think you’re showing any signs.

How do I know if I have Hepatitis?

Viral hepatitis, such as hepatitis C (HCV), hepatitis B (HBV) and hepatitis A (HAV), is diagnosed by your symptoms, a physical exam, and blood tests. Sometimes imaging studies such as a sonogram or CAT scan and a liver biopsy are also used.

Who’s at Risk?

For hepatitis C, the CDC recommends that you have a blood test if any of the following is true:

  • You have received an organ transplant or transfusion in the past
  • You have been notified that you received blood or an organ transplant from a donor who later tested positive for the disease
  • You have ever injected drugs, even once many years ago
  • You received a blood transfusion or an organ transplant before July 1992
  • You received a blood product used to treat clotting problems that was made before 1987
  • You were born between 1945 and 1965
  • You have had long-term kidney dialysis
  • You have signs or symptoms of liver disease
  • You have HIV
  • You have a known exposure to HCV
  • You have persistent elevations of a liver blood test called ALT (alanine aminotransferase levels)

Other people for whom hepatitis C virus testing is indicated include:

  • Children born to HCV-positive mothers
  • Hospital and other health care facility workers after a needle stick or exposure to the blood of a person with HCV
  • Public safety and emergency medical workers after a needle stick or exposure to the blood of a person with HCV.

The following people who are at increased risk for contracting hepatitis B virus include:

  • People who received a blood or blood-product transfusion prior to 1972
  • Hospital and health care workers
  • Household members of an infected person
  • Intravenous drug users (both present and former users)
  • People who have a tattoo or body part pierced with an infected needle
  • Sex partners of infected people
  • Travelers to countries where HBV is endemic
  • People who were born to a mother infected with HBV
  • Transplant-organ recipients who received an infected organ

The following groups of people should be screened for hepatitis B virus:

  • People born in areas where HBV is endemic
  • Men who have sex with men
  • Intravenous drug users (both present and former users)
  • Dialysis patients
  • HIV-infected people
  • Pregnant women
  • Family members, household members, and sex partners of HBV-infected people (even if sex occurred on only one occasion)
  • People who have more than one sex partner within 6 months
  • People who will need to be on medicines that will weaken their immune system

Otherwise, routine screening for hepatitis is typically not recommended unless you have symptoms or signs (such as abnormal liver-related blood tests) of the condition.

What if I have symptoms of Viral Hepatitis?

If you have symptoms or signs of viral hepatitis, your health care provider can perform a blood test to check for the presence of an antibody. If you have hepatitis, more blood samples may be necessary later – even if the symptoms have vanished – to check for complications and determine if you have progressed from acute (infected within the past six months) to chronic (having the virus for greater than six months) disease. Most people have vague or no symptoms at all; hence, viral hepatitis is often referred to as a silent disease.

Your health care provider may also require a liver biopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is ten sent to a lab to be analyzed. 

What are the Treatments for Viral Hepatitis?

The treatment for viral hepatitis depends on the type and stage of the infection. Over the last several years, excellent treatments for both hepatitis B and C have become available. More and improved treatments are being evaluated all the time.

Your primary care doctor should be able to provide adequate care of your hepatitis. However, if you have severe hepatitis, you may require treatment by a hepatologist or gastroenterologist – specialists in diseases of the liver. Hospitalization is normally unnecessary unless you cannot eat or drink or are vomiting.

Doctors sometimes recommend drug therapy for people with certain types of hepatitis. Antiviral medication for hepatitis B includes adefovir (Hepsera), entecavir (Baraclude), interferon, lamivudine (epivir), peginterferon, telbivudine (Tyzeka), and tenofovir (Viread).

Until recently, the standard treatment for chronic hepatitis C was a course of peginterferon plus ribavirin for people with genotype 2 and 3, and peginterferon plus ribavirin plus a protease inhibitor for people with genotype 1. These treatments had been shown to be effective in between 50%-80% of those infected with hepatitis C but the side effects were very difficult for people to manage.

Treatment now centers around direct acting antiviral drugs (DAAs). These medicines are highly effective for most people with hepatitis C and interferon-free and often ribavirin-free. This means they typically have fewer side effects. The treatments are often simpler- consisting of fewer pills for a shorter amount of time. DAAs are available as either single drugs or combined with other medications in one pill. Elbasvir-grazoprevir (Zepatier), ledipasvir-sofosbuvir (Harvoni), and sofosbuvin-velpatasvir (Epclusa) and are once daily combination pills. Depending on the type of hepatitis C infection, these can often cure the disease in 8 to 12 weeks. Other treatment options include: ombitasvir-paritaprevir-ritonavir (Technivie), or some combinations of daclatasvir (Daklina), peginterferon, ribavirin, or sofosbuvir (Sovaldi). Ask your doctor what’s best for you, based on your medical needs.

Hepatitis in Pregnant Women

Hepatitis in pregnant women usually does not increase the risk of birth defects or other pregnancy problems, and infection of the unborn baby is rare. However, hepatitis E can be fatal to a pregnant woman during her third trimester, and if the mother has hepatitis B, the baby is likely to contract the disease at birth.

If you are pregnant, your doctor will test you for hepatitis B; if you are infected with the virus, your baby will be given immune globulin shots and a hepatitis vaccination. This will help protect your baby from contracting the virus. In addition, it may be recommended that a mother with active HBV receive treatment with an antiviral medication during the third trimester of pregnancy.

Other points to Consider

If your hepatitis, either viral or nonviral, is in the acute stage (occurred within the last six months), avoid alcoholic beverages, as your body’s efforts to process alcohol puts an added strain on an already injured liver. Also, be aware that your sexual partners, especially if have hepatitis B, may run the risk of contracting the disease. Hepatitis C is difficult to pass through sexual contact, unless there is blood-to-blood contact.

Most adults recover completely from acute hepatitis A and B within six months. Mild flare-ups may occur over a period of several months as the disease is subsiding, but each flare-up is usually less severe than the one before it, and a relapse doesn’t mean you won’t make a full recovery.

Prevention

There are many ways to prevent hepatitis, from getting a vaccine to washing your hands well. But it all depends on what type you have. 

How to Prevent Hepatitis A

You can get hepatitis A if you eat food or drink water that has the hepatitis A virus in it. You could also get infected if you’re in close physical contact with someone who has the disease or have sex with someone who has it.

The best way to prevent hepatitis A is to get a vaccine. Kids should get a shot around their first birthday.

As an adult, you should get the shot if you:

  • Travel to Africa, Asia (except Japan), the Mediterranean, Eastern Europe, the Middle East, Central and South America, Mexico and parts of the Caribbean
  • Use recreational drugs
  • Are in the military
  • Work in a day care center, nursing home, or you’re a health care professional
  • Have long-term liver disease
  • Take blood products to treat hemophilia or other conditions

If you’re planning a trip to a place where there are outbreaks of hepatitis A, keep in mind that the vaccine only starts to work 2 to 4 weeks after you get it. And if you want long-term protection, you’ll need a follow-up shot 6 to 12 months later.

If you didn’t get your hepatitis A vaccine a month before you travel, you may be able to get a shot of hepatitis A immune globulin before you leave. This may prevent hepatitis A infection if you get it within 2 weeks before or after you come into contact with the virus.

If you’re traveling to places where the virus is common, be careful about what you eat and drink. Unclean water and ice, as well as fruits, veggies, and undercooked foods, are common causes of hepatitis A infections. This means you should:

  • Avoid “street” food
  • Only drink bottled water and use it to brush your teeth. You can also boil your tap water for at least 1 minute
  • Don’t sip on cocktails and other drinks with ice cubes
  • Skip dairy products and undercooked meat and fish
  • Don’t order salads or fresh fruit from restaurants, since you don’t know if it was washed with clean water
  • Peel and wash your own greens using bottled water
  • Wash your hands well after you go to the restroom, change diapers, or before you eat or serve food

Be extra careful if you work at a day care center or any place where lots of people are in close quarters, especially if you’re in contact with an infected person’s stool, blood, saliva, or other body fluids.

How to Prevent Hepatitis B

You can get hepatitis B if you have contact with the blood, semen, or other body fluids of someone who’s infected. A common way it spreads is through sex or sharing needles with a person who has the disease.

You can prevent infection with a vaccine. The CDC recommends that babies get their first dose shortly after they’re born. They’ll need follow-up shots when they’re between 6 and 18 months old. Kids under age 19 who missed any shots in the series should get catch-up doses.

If you haven’t had a hepatitis B shot as an adult, it’s important to get it if you:

  • Have kidney disease, long-term liver disease, or are infected with HIV
  • Have more than one sex partner
  • Are a man who has sex with men
  • Inject illicit drugs
  • Work in health care
  • Live with someone who has hepatitis B
  • Travel to a country with outbreaks of hepatitis B

Besides a vaccine, the best way to prevent hepatitis B is to avoid contact with other people’s blood and body fluids. That means:

  • Don’t share toothbrushes or razors
  • Don’t use someone else’s needle if you inject illicit drugs.
  • Only get tattoos and piercings from shops that can show you how they sterilize their gear
  • Use a latex or polyurethane condom when you have sex

You can’t get infected with hepatitis B by kissing, hugging, coughing, sneezing, or sharing glasses or silverware.

If you think you may have been infected with hepatitis B and you never had a vaccine, let your doctor know. You may be able to prevent an infection if you get a hepatitis be immune globulin shot. If you think you may have picked up hepatitis B through sex, you’ll need to get this shot within 14 days. If your infection is from other causes, you’ll need to get the shot within 24 hours.

How to Prevent Hepatitis C

There’s no vaccine for hepatitis C. And because most people don’t have symptoms for years, many don’t know they’ve been infected.

Take these steps to protect yourself from catching hepatitis C:

  • If you use illicit drugs, don’t share needles
  • Know your partner’s sexual history. If you think they may be infected, get tested
  • Use a condom when you have sex