Hepatitis

WEB EXCLUSIVE / SEPTEMBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in February 2000

Download this Patient Note in PDF format

Hepatitis is an inflammation of the liver usually caused by a virus or, less often, by certain medications or chemical agents, such as alcohol, carbon tetrachloride and, when taken in large amounts, acetaminophen.

The three main types of hepatitis are labeled A, B, and C. Each year, about 195,000 persons in the United States are infected with the hepatitis A, B, and C viruses.

Hepatitis A is the most common form of hepatitis. The hepatitis A virus is transmitted primarily by contaminated food or water. Most people recover completely from this infection. A vaccine is available to protect those who are at high risk, such as international travelers and healthcare and child-care workers.

Hepatitis B is more serious than hepatitis A and can cause permanent liver damage. This viral infection is usually acquired through exposure to contaminated blood. Intravenous drug users who share contaminated needles are at highest risk. But also at risk are persons who have multiple sexual partners, who are healthcare workers, who have repeated blood transfusions, or who need dialysis to maintain kidney function in the long term. Blood donor screening tests have greatly reduced the dangers of blood transfusions, and a highly effective vaccine is available to protect people who are likely to come in contact with the hepatitis B virus. Most children are now vaccinated to protect them from this infection.

Hepatitis C is the form that causes the most serious lifelong problems. The hepatitis C virus usually spreads by exposure to contaminated blood or needles (often through body piercing or tattooing) or by sexual contact with someone who has the infection. About 4 million people in the United States are or have been infected with this virus, but most of them have no symptoms and are not aware of their risk of progressive liver disease. No vaccine is yet available for hepatitis C.

What are the symptoms?
It can be very difficult to tell the forms of hepatitis apart by their symptoms. Many people think they have the flu because of the fatigue, abdominal pain, loss of appetite, nausea, and vomiting that may occur with a hepatitis infection. Yellow skin (jaundice) and dark-colored urine can be important clues to a liver problem and should be checked out by a doctor. However, many people don't recall any symptoms at all. In some cases, the virus is found during a routine blood test.

What are the risks with hepatitis C?
About 15% of people infected with hepatitis C fight off the virus with no liver damage. For the rest, the disease slowly and silently attacks the liver. Long-term scarring (cirrhosis) of the liver may develop in about half of these people, and liver cancer or liver failure occurs in about half of those who have cirrhosis. Hepatitis C is the main reason people need liver transplants.

What treatments are available for hepatitis?
Therapy often depends on specific symptoms. Most people recover from hepatitis A or B infection with no special treatment, although some become carriers of the virus. For chronic hepatitis B, therapy may include the drugs interferon, lamivudine, adefovir dipivoxil, and entecavir, which stop the virus from multiplying. People who have hepatitis C might need interferon alone or in combination with a drug called ribavirin. These treatments are not right for everyone, however, and research is under way on new drugs and drug combinations for treatment of hepatitis C.

In the meantime, if you have hepatitis C, you should consider these lifestyle changes.

• Eliminate alcohol from your life. It is a liver toxin and seems to speed progression of liver disease.
• Avoid medications that could damage your liver. Your doctor can tell you which drugs not to take.
• Live a healthful lifestyle. Eat right and exercise to stay as fit as possible. Practice safe sex. Cover wounds that could expose others to your blood, and never share toothbrushes, razors, or nail clippers. Be sure to tell your healthcare providers about any past hepatitis infection.

Who should be tested for hepatitis C? Symptoms of hepatitis C often do not show up for years. You should be tested for this disease if you: Had body or ear piercing, tattoos, or acupuncture using unsterile needles Received a blood transfusion or organ transplant before July 1992 Used illicit intravenous or intranasal drugs--even if used only once or a long time ago Were exposed to blood of a person who might have hepatitis Are a military veteran who was exposed to blood or other body fluids in combat Were given clotting factor concentrates made before 1987 Received long-term dialysis Have had unprotected sex with multiple partners Are a man who has sex with men Have unprotected sex with a sole partner who is known to have hepatitis C If you are wondering about your personal risk of hepatitis, talk with your doctor.

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste