Showing posts with label Hepatitis. Show all posts
Showing posts with label Hepatitis. Show all posts

10 December 2007

Hepatitis C

Topic Overview

  • Hepatitis C is a virus that causes a liver infection. It can lead to liver damage over time.
  • You get the virus by coming in contact with an infected person’s blood. The most common way to get it is by sharing needles or other tools to inject drugs. But often people don't know how they got it.
  • Most people who get the virus have it for life. But hepatitis C damages your liver very slowly. So you may feel healthy for a long time.
  • You may not know for many years that you have the disease. This is because chronic hepatitis C usually has no ongoing symptoms. A blood test can tell you if you have the virus. You may find out you have hepatitis C by accident, such as when donating blood or during a checkup.
  • You and your doctor need to decide if you should take medicine to treat the virus. It may not be right for everyone. Medicine does not always work, has side effects, and costs a lot.
  • If you have hepatitis C, avoid alcohol and drugs and certain medicines that can be hard on your liver. This may help prevent further liver damage.

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, many people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

You can get hepatitis C if:

  • You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
  • You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
  • You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure if you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small.

 

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Many people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

  • Feeling very tired.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out that they have the virus by accident, when their blood is tested before a blood donation or as part of a regular checkup. Often, people with hepatitis C will have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, you have had hepatitis C at some point. A second test can tell if you have hepatitis C now.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see if the virus has caused scarring in your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. See a picture of the placement of the needle for a liver biopsy.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.

How is it treated?

You and your doctor need to decide if you should take antiviral medicine to treat hepatitis C. It may not be right for everyone. If your liver damage is mild, you may not need medicine.

If you do take medicine, the best treatment is a combination of two medicines that fight infection: peginterferon and ribavirin. How well these medicines work depends on how damaged your liver is, how much virus you have in your liver, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C do not notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.

 

Cause

Hepatitis C is a liver disease that is caused by infection with the hepatitis C virus, a virus that lives in your liver cells.

How it spreads

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or water with someone. You can get hepatitis C if you come into contact with the blood of someone who has hepatitis C.

The most common way to get hepatitis C is by sharing needles and other equipment (such as cotton, spoons, and water) used to inject illegal drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you get into a drug treatment program.

Before 1992, people could get hepatitis C through blood transfusions and organ transplants. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure whether you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small. Your risk is especially low if you are in a long-term, monogamous relationship.

If you live with someone who has hepatitis C or you know someone with hepatitis C, you generally do not need to worry about getting the disease. You can help protect yourself by not sharing anything that may have blood on it, such as razors, toothbrushes, and nail clippers.

Contagious and incubation periods

The incubation period is the time it takes for symptoms to appear after the hepatitis C virus has entered your body, and it is any time from 2 weeks to 6 months.

Anyone who has hepatitis C can spread the virus to someone else. If testing shows you have hepatitis C, do not share needles, and keep cuts, scrapes, and blisters covered.

Complications:

Hepatitis C and Liver Cancer

Hepatitis C virus (HCV) infection is also associated with the development of liver cancer. In fact, in Japan, hepatitis C virus is present in up to 75% of cases of liver cancer. As with hepatitis B virus, the majority of hepatitis C virus patients with liver cancer have associated cirrhosis (liver scarring). In several retrospective-prospective studies (looking backward and forward in time) of the natural history of hepatitis C, the average time to develop liver cancer after exposure to hepatitis C virus was about 28 years. The liver cancer occurred about 8 to 10 years after the development of cirrhosis in these patients with hepatitis C. Several prospective European studies report that the annual incidence (occurrence over time) of liver cancer in cirrhotic hepatitis C virus patients ranges from 1.4 to 2.5% per year.

In hepatitis C virus patients, the risk factors for developing liver cancer include the presence of cirrhosis, older age, male gender, elevated baseline alpha-fetoprotein level (a blood tumor marker), alcohol use, and co-infection with hepatitis B virus. Some earlier studies suggested that hepatitis C virus genotype 1b (a common genotype in the U.S.) may be a risk factor, but more recent studies do not support this finding.

The way in which hepatitis C virus causes liver cancer is not well understood. Unlike hepatitis B virus, the genetic material of hepatitis C virus is not inserted directly into the genetic material of the liver cells. It is known, however, that cirrhosis from any cause is a risk factor for the development of liver cancer. It has been argued, therefore, that hepatitis C virus, which causes cirrhosis of the liver, is an indirect cause of liver cancer.

On the other hand, there are some chronic hepatitis C virus infected individuals who have liver cancer without cirrhosis. So, it has been suggested that the core (central) protein of hepatitis C virus is the culprit in the development of liver cancer. The core protein itself (a part of the hepatitis C virus) is thought to impede the natural process of cell death or interfere with the function of a normal tumor suppressor (inhibitor) gene (the p53 gene). The result of these actions is that the liver cells go on living and reproducing without the normal restraints, which is what happens in cancer.

 

Conditions associated with Hepatitis C

Several extra-hepatic (outside of the liver) conditions are associated with chronic hepatitis C. These conditions are not very common and their occurrence does not correlate with the severity of the underlying liver disease. The most widely described associated condition is cryoglobulinemia. This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels, thereby causing inflammation of the vessels (vasculitis) in tissues throughout the body. For example, the skin, joints, and kidneys (glomerulonephritis) may be involved.

Patients with cryoglobulinemia can have quite a variety of symptoms. These symptoms may include weakness, joint pain or swelling (arthralgia or arthritis), a raised, purple skin rash (palpable purpura) usually in the lower portion of the legs, swelling of the legs and feet due to loss of protein in the urine from the kidney involvement, and nerve pain (neuropathy). In addition, these patients may develop Raynaud's phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in cold temperatures.

The diagnosis of cryoglobulinemia is made by doing a special test in the laboratory to detect the cryoglobulins in the blood. In this test, the cryoglobulins are identified when the blood sample is exposed to the cold (cryo means cold). In addition, a finding of typical inflammation of small blood vessels in certain tissue biopsies (e.g., the skin or kidney) supports the diagnosis of cryoglobulinemia. All of the symptoms of cryoglobulinemia often resolve with successful treatment of the hepatitis C virus infection.

B-cell non-Hodgkin's lymphoma, a cancer of the lymph tissue, has also been associated with chronic hepatitis C virus. The cause is thought to be the excessive stimulation by the hepatitis C virus of B-lymphocytes, which results in the abnormal reproduction of the lymphocytes. Interestingly, the disappearance (remission) of an hepatitis C virus-associated low-grade (not very active) non-Hodgkin's lymphoma has been reported with interferon therapy. Most individuals with hepatitis C virus-associated high-grade non-Hodgkin's lymphoma, however, will require the usual anti-cancer therapies.

Two skin conditions, lichen planus and porphyria cutanea tarda, have been associated with chronic hepatitis C virus. It is important to know that both of these skin conditions can resolve with successful interferon therapy for the hepatitis C virus. In addition, up to 25% of hepatitis C virus patients have autoimmune antibodies (against one's own proteins), such as anti-nuclear antibody, anti-smooth muscle antibodies, and rheumatoid factor.

Exams and Tests

Asking questions about your medical history and doing a physical exam will help your doctor determine your chances of having hepatitis C. Often, people find out by accident that they have hepatitis C, such as when donating blood or having a routine physical exam. High liver enzymes in your blood may be the first sign of the virus.

To check how well your liver is working, you may have liver function tests. These are blood tests that can help your doctor find out if you have liver damage.

If your doctor thinks that you may have hepatitis C, he or she will order a hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. If you have hepatitis C antibodies, you will have another blood test that looks for the genetic material (RNA) of the hepatitis C virus. The antibody test shows whether you have been exposed to the virus, and the RNA test shows whether you are infected with the virus now. Before having these tests, your doctor should talk to you about the pros and cons of testing for hepatitis C so that you understand what having the virus means.

If your test results are positive, your doctor may order a liver biopsy to see whether the virus has caused scarring or damage to your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to be examined under a microscope. See a picture of the placement of the needle for a liver biopsy.

Your doctor also may order some imaging tests such as a CT scan, MRI, or ultrasound to make sure that you do not have liver cancer. You also may have a blood test to determine the kind of hepatitis C virus (genotype) you have. Knowing your genotype and the extent of your liver damage will help you and your doctor decide if and how you should be treated.

Early Detection

You should be tested for hepatitis C if you:

  • Have signs or symptoms of liver disease, such as abnormal liver tests.
  • Received blood from a donor who was found to have hepatitis C.
  • Have ever shared needles while using drugs, even if you only experimented many years ago.
  • Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids.
  • Have a sex partner who has a chronic hepatitis C infection.
  • Have had your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
  • Received blood, blood products, or a solid organ from a donor before 1992. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.
  • Received blood-clotting factor concentrates (used to treat blood disorders such as hemophilia) before 1987. In 1987, screening of clotting factor concentrates for hepatitis C became a requirement.

Some people prefer to find out on their own whether they have been exposed to hepatitis C. In most drugstores you can buy a home test called the Home Access Hepatitis C Check kit. If test results show that you have been exposed to the virus, it is important to discuss these results with your doctor and to find out if you are infected with the virus now.

Should I be tested for hepatitis B and C?

If you are diagnosed with hepatitis C, your doctor will talk to you about how to prevent spreading the virus. He or she also will recommend that you protect your liver by getting shots to prevent hepatitis A and hepatitis B. You may also get tested for HIV. Your doctor also may talk to you about how alcohol can damage your liver.

 

Treatment Overview

Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.

You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.

The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.

Treatment of short-term (acute) hepatitis C

Most people with acute hepatitis C do not get treated, because they do not know they have the virus.

If a person knows that he or she may have been exposed to the virus-such as a health care worker who is stuck by a needle-acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4

Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.

Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.

 

If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.

Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.

Antiviral medicines for hepatitis C may not be recommended if you:

  • Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
  • Have advanced cirrhosis.
  • Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
  • Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
  • Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Antiviral medicines to treat hepatitis C include:

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If tests show that the virus is no longer present, treatment may be shortened from 1 year to 6 months (genotype 1) or from 6 month to 3 months (genotype 2 or 3). If your liver does not improve after 3 months of treatment, your treatment may be stopped.

Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.7

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment of relapse or nonresponse

Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.

Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.8 Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.

What To Think About

If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.

Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.9

 

Home Treatment

Some people with hepatitis C do not notice a big difference in the way they feel. Others feel tired, sick, or depressed. The following are steps you can take at home that may help you feel better both physically and emotionally.

Slow down

It is very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If possible, ask others to help out around your home or ask your employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic exercise can help you have more energy and may also improve depression. It is best to avoid any strenuous activities on the day after you receive peginterferon.7

Eat regular, nutritious meals

Sometimes, people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you do not feel like eating, it is very important to eat small meals throughout the day. Some people experience nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

Avoid alcohol and drugs

One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

If you use illegal drugs or alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance abuse problems. If you do not feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.

Control itching

If you develop itchy skin, ask your doctor about taking nonprescription medicines, such as diphenhydramine (for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to relieve itching. If you do take these medicines, be sure to follow the instructions and to stop using the medicine if you have any side effects.

Seek help for depression

Depression may develop in anyone who has a long-term illness. It also can be a side effect of antiviral medicines for hepatitis C. If you are feeling depressed, talk to your doctor about antidepressant medicines and/or counseling. For more information, see the topic Depression.

Learn about the disease

Learning about hepatitis C may help you feel more in control of the disease. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

 

Medications

Antivirals are the only medicines used to treat long-term (chronic) hepatitis C. These medicines can help prevent the hepatitis C virus from damaging your liver. If these medicines work for you, you may have no more virus in your body and less inflammation and scarring in your liver.

Medication Choices

The following antiviral medicines are used to treat chronic hepatitis C:

What To Think About

Antiviral medicines for hepatitis C may not be recommended if you:

  • Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
  • Have advanced cirrhosis.
  • Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
  • Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment.
  • Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. If your liver does not show signs of improvement after 3 months of treatment, your treatment may be stopped.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?
Treatment effectiveness

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin.

Medicines to treat hepatitis C do not work for everyone. Chronic hepatitis C infection is cured or controlled in about half of the people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.7

 

Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2

If you have tried interferon in the past and did not get good results, talk to a doctor who is a liver specialist (hepatologist). The hepatologist will be able to tell you about newer combinations of peginterferon with ribavirin or new, experimental medicines.

 

Surgery

If chronic hepatitis C damages your liver so severely that it no longer works well (end-stage liver failure), you may need a liver transplant to extend your life. Liver transplants are not common.

Surgery Choices

A liver transplant is the only surgical treatment that can help people with end-stage liver failure.

What To Think About

Liver transplantation is a risky, expensive procedure, and donor organs are hard to come by. Most of the time, only people who are in good health (other than having liver disease) are considered for a transplant. You will not be considered if you are using alcohol or drugs or have certain mental health problems.

After a liver transplant, you will need lifelong follow-up care by a specialist. You also will need to take immunosuppressant medicine to keep your body from rejecting the new liver, which may cause you to develop other problems.

Hepatitis C almost always infects the newly transplanted liver. Recurring liver disease after a transplant can be a serious problem and may cause the new organ to fail. But most patients do very well after a liver transplant and are able to live normal lives.

WebMD Medical Reference from Healthwise

Last Updated: August 27, 2007

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

@ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

 

Reference Link:

http://www.webmd.com/hepatitis/hepc-guide

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Hepatitis B

What is hepatitis B?

Hepatitis B is a virus that infects the liver. Most adults who get hepatitis B have it for a short time and then get better. This is called acute hepatitis B.

You can have hepatitis B and not know it. You may not have symptoms. If you do, they can make you feel like you have the flu. But as long as you have the virus, you can spread it to others.

Sometimes the virus does not go away. This is called chronic hepatitis B. Over time, it can damage your liver. Babies and young children infected with the virus are more likely to get chronic hepatitis B.

What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It is spread through contact with the blood and body fluids of an infected person.

You can get hepatitis B if you:

  • Have sex without using a condom.
  • Share needles to inject drugs.
  • Get a tattoo or piercing with tools that were not cleaned right.
  • Share personal items like razors or toothbrushes.

A mother who has the virus can pass it to her baby during delivery. If you are pregnant and think you may have been exposed to hepatitis B, get tested. If you have the virus, your baby can get shots to help prevent the virus.

You cannot get hepatitis B from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drinks.

What are the symptoms?

Many people with hepatitis B do not know they have it, because they do not have symptoms. If you do have symptoms, you may just feel like you have the flu. Symptoms include:

  • Feeling very tired.
  • Mild fever.
  • Headache.
  • Not wanting to eat.
  • Feeling sick to your stomach or vomiting.
  • Belly pain.
  • Diarrhea or constipation.
  • Muscle aches and joint pain.
  • Skin rash.
  • Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people with chronic hepatitis B have no symptoms.

How is hepatitis B diagnosed?

A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. Your doctor will also be able to tell if you have had the vaccine to prevent the virus.

If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing. This is called a liver biopsy.

How is it treated?

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs.

Treatment for chronic hepatitis B depends on whether the virus is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide whether medicine is the right treatment for you.

 

Sometimes chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

Can hepatitis B be prevented?

The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of three shots. Adults at risk and all babies, children, and teenagers should be vaccinated.

To avoid getting or spreading the virus to others:

  • Use a condom when you have sex.
  • Do not share needles.
  • Wear latex or plastic gloves if you have to touch blood.
  • Do not share toothbrushes or razors.

 

Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most easily spread (contagious) forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. However, hepatitis has many other causes, including some medications, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.

How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:

  • Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
  • Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
  • Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument infected with an infected person's blood, or if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
  • Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother's body fluids in the birth canal (perinatal transmission). However, breast-feeding does not transmit the virus from a woman with HBV to her child.
  • Body piercings and tattoos. HBV can be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person's skin.
  • Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Today, all donated blood in the United States is screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion.

Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

  • Blood contains the highest quantities of the hepatitis B virus.
  • Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as the condition lasts.

 

Symptoms

Less than half of those with short-term (acute) hepatitis B infections have symptoms. Symptoms include:

  • Jaundice (the skin and whites of the eyes appear yellow). Although jaundice is the defining sign of hepatitis B, it does not occur in most cases. Jaundice usually appears after other symptoms have started to go away.
  • Extreme tiredness (fatigue).
  • Mild fever.
  • Headache.
  • Loss of appetite.
  • Nausea.
  • Vomiting.
  • Constant discomfort on the right side of the abdomen under the rib cage, where the liver is located. In most people, the discomfort is made worse when their bodies are jarred or if they overwork themselves.
  • Diarrhea or constipation.
  • Muscle aches.
  • Joint pain.
  • Skin rash.

Most people with chronic HBV have no symptoms.

If you were infected with acute HBV but had no symptoms, you may not find out that you once had hepatitis B, or that you currently have long-term (chronic) HBV infection, until you have a routine blood test or donate blood or until a family member or someone you live with is found to be infected. Some people never know they have hepatitis B until a health professional finds that they have cirrhosis or liver cancer (hepatocellular carcinoma). However, this is uncommon.

 

Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most easily spread (contagious) forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. However, hepatitis has many other causes, including some medications, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.

How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:

  • Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
  • Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
  • Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument infected with an infected person's blood, or if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
  • Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother's body fluids in the birth canal (perinatal transmission). However, breast-feeding does not transmit the virus from a woman with HBV to her child.
  • Body piercings and tattoos. HBV can be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person's skin.
  • Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Today, all donated blood in the United States is screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion.

Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

  • Blood contains the highest quantities of the hepatitis B virus.
  • Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as the condition lasts.

 

Exams and Tests

Your health professional will diagnose hepatitis B virus (HBV) infection based on a physical examination, your medical history, and blood tests. You will be asked questions about risk factors for hepatitis B (such as about your job or sexual activity) and about factors that could make the disease worse (such as your alcohol use or family history of liver cancer).

If your health professional thinks you have been exposed to or are infected with the virus, you will need tests to find out more about your condition.

Hepatitis blood tests include:

  • Hepatitis B antigens and antibodies, which help determine whether you are or were once infected with HBV, whether you have been immunized, whether you have long-term (chronic) HBV infection, and whether you can pass the virus to others (contagious).
  • Hepatitis B viral DNA (HBV DNA), which detects genetic material (DNA) from the hepatitis B virus. HBV DNA indicates that the virus is multiplying in your body (active) and that it is contagious.
  • Tests that determine whether the hepatitis A, hepatitis C, or Epstein-Barr (which causes infectious mononucleosis, or "mono") viruses are causing your hepatitis if the results of your tests show that HBV is not multiplying in your body.
  • Tests that determine the cause of liver inflammation if it is not a viral cause.
  • Tests that determine whether you are infected with hepatitis D along with hepatitis B.
Should I be tested for hepatitis B and C?

Liver tests include:

Tests may be done if you have chronic HBV infection and are considering antiviral treatment. These tests also may be used to determine whether treatment has been helpful in controlling liver damage caused by chronic HBV infection. They include:

If you have chronic hepatitis B, the U.S. Centers for Disease Control and Prevention (CDC) recommends that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on Hepatitis A, see the topic Hepatitis A.

If you are at risk for liver cancer, an alpha-fetoprotein (AFP) test may be done. If the AFP level is elevated, it may indicate liver cancer.

 

If you have chronic HBV infection, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus in your body. Some of the tests can tell your health professional whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to cirrhosis or liver cancer (hepatocellular carcinoma).

Early Detection

The CDC recommends that all pregnant women have the hepatitis B surface antigen test. This test also may be repeated later in the pregnancy if a woman is at high risk for infection. For more information on risk factors, see the What Increases Your Risk section of this topic.

People who were once exposed to the hepatitis B virus, especially people who moved to the United States from a country where the virus is common, often develop lifelong protection (immunity) against HBV and do not need to be vaccinated. However, people from countries where HBV infection is common may carry the virus and should be screened for the virus.

You can be screened for hepatitis B before getting vaccinated. However, keep in mind that:

  • Hepatitis B vaccination (What is a PDF document?) may cost less than screening. Screening costs include the cost of a health professional visit and laboratory tests. If antibodies against HBV are not found, you will have to pay for the full vaccination series (three shots given at different times), including the cost of additional office visits.
  • You can receive the hepatitis B vaccine even if you already have antibodies against HBV in your bloodstream, and no harm will result.

 

Treatment Overview

Treatment of hepatitis B viral (HBV) infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis. Short-term (acute) hepatitis B usually goes away on its own; home treatment is used to relieve symptoms and help prevent spread of the virus. In long-term (chronic) HBV infection, treatment includes monitoring the condition and using antiviral medications to prevent liver damage. If hepatitis B has severely damaged your liver, a liver transplant may be considered.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for chronic hepatitis B based on the presence of hepatitis B antigens in your blood, the level of HBV DNA in your blood, and the levels of your liver enzymes.4

Initial treatment

Your initial treatment for hepatitis B (HBV) infection depends on whether you are seeing your health professional because you believe you may have recently been infected with the hepatitis B virus (HBV), you have the symptoms of acute HBV infection, or you have chronic HBV infection.

If you believe you have recently been exposed to HBV, you should receive a shot of hepatitis B immune globulin (HBIG) and the first of three immunization shots of hepatitis B vaccine(What is a PDF document?). It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the more effective treatment is.

If you have the symptoms of acute hepatitis B, treatment with medication is usually not needed. Home treatment usually will relieve your symptoms and help prevent the spread of the virus. To help relieve symptoms and prevent the spread of the infection:

  • Slow down to reduce fatigue. Reduce your activity level to match your energy level. Don't go to work or school unless your workload can be reduced to match your energy level. Avoid strenuous exercise. As you start to feel better, go back to your regular activities gradually.
  • Eat right. Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
  • Drink plenty of liquids to avoid dehydration. It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting. Drink plenty of water and, if you can tolerate them, drink fruit juices and broth to obtain additional calories. Rehydration drinks help replenish electrolytes.
  • Avoid alcohol and drugs. Hepatitis B makes it difficult for your liver to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can worsen liver damage. You should avoid alcohol until your health professional feels that your liver is completely healed, which may take as long as 3 to 4 months. Ask your health professional about using prescription medications.
  • Try to control itching. People with hepatitis B sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control itching. Talk to your health professional before taking nonprescription medications.
  • Prevent the spread of HBV by informing people you live with or sleep with about the illness, not sharing personal toiletries (such as razors and toothbrushes), and using a condom or abstaining from sex.

For more information on treating the symptoms of acute HBV infection, see the Home Treatment section of this topic.

If you have chronic HBV infection, treatment depends on how active the virus is in your body and the potential for liver damage. The goal of treatment is to stop liver damage by preventing the virus from multiplying.

Antiviral medication is used if the virus is active and you are at risk for liver damage. Medication slows the ability of the virus to multiply. Antiviral medicine for hepatitis B includes:

Should I use antiviral therapy for chronic hepatitis B?

Whether or not you are taking medication, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver damage and disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

Ongoing treatment

Ongoing treatment for chronic hepatitis B (HBV) infection consists of using antiviral medication (if necessary) and seeing your health professional on a regular basis to monitor the virus and check for liver damage.

Antiviral medication for hepatitis B includes:

Should I use antiviral therapy for chronic hepatitis B?

Whether or not you are taking medication, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver damage and disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

Treatment if the condition gets worse

Hepatitis B (HBV) infection can lead to liver damage and diseases such as cirrhosis or liver cancer (hepatocellular carcinoma). If you develop significant liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.

Home Treatment

Home treatment is important for relieving symptoms and preventing the spread of hepatitis B virus (HBV).

While there is no specific medical treatment for short-term (acute) hepatitis B, there are some things you can do that may help you feel better while the illness is running its course.

Slow down
  • Reduce your activity level to match your energy level. You don't have to stay in bed, but listen to your body and slow down when you become tired.
  • Don't go to work or school unless your workload can be reduced to match your energy level.
  • Avoid strenuous exercise.
  • As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.
Eat right
  • Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
  • Health professionals used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.
Avoid dehydration

It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting.

  • Drink plenty of water.
  • If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories.
  • Many of the "sports drinks" available in grocery stores can help replace essential minerals (electrolytes) that are lost during vomiting. You can also make your own rehydration drink.
Avoid alcohol and drugs

Hepatitis impairs your liver's ability to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can worsen liver damage.

  • If you are taking prescription medications, your health professional may instruct you to stop using them until your liver has had time to heal. Do not stop taking prescription medications unless your health professional has told you to do so.
  • Check with your health professional before taking any new medications or continuing the use of nonprescription medications, including herbal products and acetaminophen (such as Tylenol). Acetaminophen can worsen liver disease, especially if you continue to drink alcohol.
  • You should avoid alcohol until your health professional feels that your liver is completely healed. This may take as long as 3 to 4 months.
Try to control itching

People with hepatitis sometimes develop itchy skin. You can control itching by keeping cool and out of the sun, wearing cotton clothing, or using nonprescription medications, such as Benadryl or Chlor-Trimeton. Talk to your health professional if you want to take nonprescription medications.

 

Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects.

See your health professional regularly if you have chronic HBV infection

If you have been diagnosed with long-term (chronic) HBV infection, your health professional will recommend that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on hepatitis A, see the topic Hepatitis A. You also will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

 

Medications

For people with short-term (acute) hepatitis B infection (HBV), treatment with medication is not recommended. Antiviral medication may be used for long-term (chronic) HBV infection if the virus is multiplying or liver damage exists or may develop.

However, antiviral therapy is not recommended for everyone who has chronic hepatitis B viral infection. It is an option for people who have or appear likely to develop liver damage such as cirrhosis. Antiviral therapy does not help if you already have severe liver damage.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for long-term (chronic) hepatitis B based on the presence of hepatitis B antigens in your blood, the level of hepatitis B virus DNA (HBV DNA) in your blood, and the levels of your liver enzymes.4

Medication Choices
Should I use antiviral therapy for chronic hepatitis B?
What To Think About
  • It is important to weigh the benefits of treatment against the risks. Treatment for chronic hepatitis B works in about 40% of people who receive it.2
  • Interferons are given as shots. Adefovir, lamivudine, and entecavir are pills.
  • Interferons have common side effects, including fever, headaches, and hair loss. They may also cause or aggravate mental problems. Adefovir, lamivudine, and entecavir have few side effects but generally need to be taken for a longer period of time.
  • After you have taken lamivudine for 1 year or longer, you can become resistant to the drug. Drug resistance means the medicine no longer works very well. If you develop resistance to lamivudine, you can take adefovir.
  • If you have cirrhosis, you cannot use interferons. But you can use lamivudine.
  • After any kind of treatment for hepatitis B, the virus may return (relapse).
  • Adefovir was approved in 2002 and entecavir was approved in 2005, so the long-term effects of these two medicines are not yet known.

 

Surgery

Hepatitis B is a viral infection that affects the liver. There is no surgical treatment for hepatitis B.

If you develop significant liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.

In rare cases, short-term (acute) hepatitis B progresses rapidly to liver failure, a life-threatening condition called fulminant hepatitis. For some people, liver transplantation offers the only hope for survival.

 

WebMD Medical Reference from Healthwise

Last Updated: November 04, 2005

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

@ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated

 

Reference Link:

http://www.webmd.com/hepatitis/hepb-guide

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Hepatitis A

What is hepatitis A?

Hepatitis A is a liver infection caused by a virus. It goes away on its own in almost all cases. Hepatitis A does not lead to long-term liver problems.

Other forms of the virus (hepatitis B and hepatitis C) also cause hepatitis. Hepatitis A is the most common type.

How is hepatitis A spread?

The disease is caused by the hepatitis A virus. The virus is found in the stool of an infected person. It is spread when a person eats food or drinks water that has come in contact with infected stool.

Sometimes a group of people who eat at the same restaurant can get hepatitis A. This can happen when an employee with hepatitis A doesn't wash his or her hands well after using the bathroom and then prepares food.

The disease can also spread in day care centers. Workers can spread the virus if they don't wash their hands well after changing a diaper.

Some things can raise your risk of getting hepatitis A, such as eating raw oysters or undercooked clams. If you're traveling in a country where hepatitis A is common, you can lower your chances of getting the disease by avoiding uncooked foods and tap water.

What are the symptoms?

After you have been exposed to the virus, it can take from 2 to 7 weeks before you see any signs of it. Symptoms usually last for about 2 months.

Common symptoms are:

  • Feeling very tired.
  • Feeling sick to your stomach.
  • Not feeling hungry.
  • Losing weight without trying.
  • Pain on the right side of the belly, under the rib cage (where your liver is).
  • A fever.
  • Sore muscles.

Older people with hepatitis A may get yellow skin (jaundice), along with dark urine and clay-colored stools.

All forms of hepatitis have similar symptoms. Only a blood test can tell if you have hepatitis A or another form of the disease.

Call your doctor right away if:

  • You have any signs of hepatitis A.
  • Someone you live with has hepatitis A.
  • You have eaten in a restaurant that has had an outbreak of the virus.
  • Your child goes to a day care center where hepatitis A has been reported.
How is hepatitis A diagnosed?

Your doctor will ask questions about your symptoms and where you have eaten or traveled. You may have blood tests if your doctor thinks you have the virus. These tests can tell if your liver is inflamed and whether you have antibodies to the hepatitis A virus. These antibodies prove that you have been exposed to the virus.

Take steps to avoid passing hepatitis A on to others. Tell people you live with or have sex with that you have hepatitis A. Wash your hands with soap and hot water right after you use the bathroom or change a diaper and before you prepare food.

How is it treated?

Topic Overview

(continued)

Hepatitis A goes away on its own in most cases. You can help yourself get better faster by drinking lots of water and eating a healthy mix of foods.

Unlike other forms of hepatitis, the hepatitis A virus does not lead to long-term illness or serious liver damage. Most people get well within a few months.

While you have hepatitis A, cut back on daily activities until all of your energy returns. As you start to feel better, take your time in getting back to your regular activities. If you try to meet your regular pace too soon, you may get sick again.

You can only get the hepatitis A virus once. After that, your body builds up a defense against it.

Can hepatitis A be prevented?

You can protect yourself from hepatitis A by getting a vaccine (Havrix or Vaqta). You will get it in a series of two shots. It is usually 100% effective if you get both shots before you are exposed to the virus.

The U.S. Centers for Disease Control and Prevention advises that all children get the hepatitis A vaccine when they are at least 1 year old.

If you have been around someone who you know has hepatitis A, getting an injection of immune globulin (IG) may prevent you from getting the disease. It’s important for you to get the shot within 2 weeks of being exposed to the virus.

Cause

Hepatitis A is caused by a virus (hepatitis A virus, or HAV) that multiplies in liver cells and is shed in stool.

How HAV is spread

Hepatitis A virus is found in the stool (feces) of a person who has hepatitis A. The virus is spread most commonly when people put food or objects contaminated with stool containing HAV into their mouths.

Large numbers of people get the virus after drinking contaminated water because, in many parts of the world, drinking water is contaminated with raw sewage. The virus also may be spread by eating uncooked food (such as raw shellfish) and unpeeled fruits and vegetables washed in contaminated water. Hepatitis A outbreaks caused by contaminated drinking water are rare in the United States because water supplies are treated to destroy the virus and other harmful organisms.

In the United States, HAV is spread mainly among people who have close contact with someone who has the virus. You can become infected with HAV if you:

  • Eat food prepared by someone who does not wash his or her hands well after using the bathroom or changing a diaper.
  • Don't wash your hands after changing a diaper.
  • Eat raw or undercooked shellfish that was harvested from waters contaminated with raw sewage.
  • Are a man and have sex with men.

Outbreaks of hepatitis A among children in day care facilities occur because children, especially those who wear diapers, may get stool on their hands and then touch objects that other children put into their mouths. Caregivers in day care centers can spread the virus if they do not wash their hands thoroughly after changing a child's diaper.

It is very rare for hepatitis A virus to be spread by infected blood or blood products. It is not known to be spread through saliva or urine.

Some people fear that hepatitis A infection is related to or increases the risk of contracting acquired immunodeficiency syndrome (AIDS). This is not true. The hepatitis A virus is not related to the human immunodeficiency virus (HIV), which causes AIDS, nor does it increase your risk of HIV infection. A person can be infected with both hepatitis A and HIV, but the two infections have nothing to do with each other.

Incubation and contagious periods

After the hepatitis A virus enters your body, the number of virus grows and grows for 2 to 7 weeks. The average incubation period is about 4 weeks.

Your stools and body fluids contain the highest levels of the virus 2 weeks before symptoms start. This is the time when you are most contagious, but you still may spread the virus after symptoms appear.

 

Symptoms

Symptoms usually appear 15 to 50 days (2 to 7 weeks) after you have been exposed to the hepatitis A virus (HAV). The average time is 4 weeks. Symptoms usually are mild and may not be noticed in children younger than 6 years of age. In older children and adults, early symptoms are often similar to those of a stomach virus. Possible symptoms include:

  • Extreme tiredness (fatigue).
  • Fever.
  • Sore muscles.
  • Headache.
  • Pain on the right side of the abdomen, under the rib cage (where the liver is located).
  • Nausea.
  • Loss of appetite and weight loss.
  • Yellowing of the skin and the white part of the eyes (jaundice), sometimes accompanied by dark urine and clay-colored (whitish) stools. Jaundice is less common in children and younger adults.

Up to 15% of people who have hepatitis A may have a second flare-up of HAV infection 1 to 4 months after infection first occurred.1 The infection is usually not any more severe than it was the first time, but arthritis can occur with it. After the infection goes away, the person usually returns to normal health. In rare cases, cholestatic hepatitis occurs, which can cause itching and can last throughout the infection.

In general, by the time symptoms appear, the amount of virus being shed in your stools is declining. You still may spread the virus, but you are less likely to do so after symptoms appear.

Symptoms of hepatitis A usually last less than 2 months.

 

When To Call a Doctor

Contact a health professional immediately if a person diagnosed with hepatitis A develops severe dehydration (caused by vomiting and an inability to hold down fluids) or any signs of rapidly developing liver failure, which include:

  • Extreme irritability (greater than would be expected when a person is ill).
  • Impaired ability to think clearly or reason.
  • Extreme drowsiness.
  • Loss of consciousness.
  • Swelling of the face, hands, feet, ankles, legs, arms, or abdomen (edema).
  • Bleeding from the nose, mouth, or rectum (including blood in stools), or under the skin.

Call a health professional today if:

  • Any of the signs or symptoms of hepatitis A develop. For more information, see the Symptoms section of this topic.
  • Someone in your household has been diagnosed with hepatitis A.
  • You have eaten in a restaurant or any other dining facility known to be the source of an outbreak of hepatitis A.
  • A child or another family member has been in a day care center or another institution where a hepatitis A outbreak has occurred.
  • Your sex partner has been diagnosed with hepatitis A.
  • You are planning a trip to a foreign country or have any other reason to believe you should be vaccinated against hepatitis A. Plan for vaccination 6 months before travel, if possible. If time is running short, getting vaccinated at least 1 month before travel offers some protection, and 2 weeks before travel may also be helpful.3
Watchful Waiting

Watchful waiting, or surveillance, is not advised if you think you have been exposed to the hepatitis A virus (HAV) or if you have symptoms of the illness.

It is important to see a health professional when symptoms develop, because all forms of viral hepatitis have similar symptoms. Only a blood test can determine whether you have hepatitis A or another hepatitis virus. A health professional also can advise you about how to prevent the spread of hepatitis A.

Who To See

Most of the time, the following health professionals can diagnose and treat hepatitis A:

If complications develop, you may need care from:

 

Exams and Tests

A thorough medical history and physical examination provide valuable information about your symptoms and whether it is likely that you have been exposed to the hepatitis A virus (HAV).

While taking a medical history, your health professional usually will ask where you have traveled, if you work in or have a child in a day care center, and if you live with someone known to have hepatitis A.

If you may have been exposed to hepatitis A, you will have blood tests to study liver function and to see whether your liver is damaged or inflamed. Blood tests to study liver function include:

  • Bilirubin. When bilirubin builds up in the blood, it may indicate hepatitis.
  • Albumin. Lower than normal levels may indicate hepatitis or other liver problems.
  • Prothrombin time, a blood test that measures how long it takes blood to clot. An abnormal prothrombin time can be caused by liver disease or injury.

Blood tests that may be done to determine whether the liver is damaged or inflamed include:

  • Alanine aminotransferase (ALT). When the liver is damaged or diseased, ALT is released into the bloodstream, causing levels of the enzyme to rise.
  • Aspartate aminotransferase (AST). When body tissues or organs such as the heart or liver are damaged, AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage.
  • Alkaline phosphatase (ALP). Large amounts of ALP in the bloodstream may indicate liver damage.
  • Lactic dehydrogenase (LDH). Many diseases can cause elevations in LDH levels. In addition to the LDH test, your doctor will usually run other tests to confirm a diagnosis of hepatitis A.

If tests show your liver is inflamed, you will have an antibody (anti-HAV) test on a sample of your blood. The presence of HAV antibodies means that HAV infection is the most likely cause of your hepatitis.

If the results of the anti-HAV test show that HAV is not multiplying in your body, your doctor may do other hepatitis blood tests to find out whether hepatitis B virus, hepatitis C virus, or Epstein-Barr virus (which causes infectious mononucleosis, or "mono") is causing your hepatitis.

Early Detection

If you are concerned that you have been exposed to the virus and you have not been previously infected or vaccinated, contact your health professional. If you get a shot of immune globulin (IG) within 2 weeks of being exposed to HAV, you probably will not develop symptoms of HAV infection.

Routine vaccination of hospital workers, food handlers, and child care center workers and attendees does not occur at this time because their chance of infection generally is no greater than that of the wider community. But some child care centers have workers get the shot because it works so well to prevent the disease. Plus there is very low chance of side effects from the vaccine. If outbreaks of HAV infection do occur in those settings, people who were exposed to the virus should receive a shot of immune globulin (IG).4

 

Treatment Overview

Hepatitis A goes away on its own in almost all cases. No medications are used to treat the illness. Home treatment will usually help relieve your symptoms and help you prevent the spread of hepatitis A virus (HAV).

Slow down

Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Don't go to work or school unless your workload can be decreased to match your energy level. Avoid strenuous exercise, until you are fully recovered. As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.

Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is very important to keep your body well-hydrated when you have hepatitis A, especially if you have been vomiting. Drink plenty of water. If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories. Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes (salts) that are lost through vomiting.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medications can make liver damage worse.

Make sure your health professional knows all the medications you are taking, including herbal products. Do not take any new medications or stop taking existing prescription medications without your doctor's approval. Talk to your health professional about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects. Tell your health professional before you start any new medicine.

Symptoms of hepatitis A usually begin to go away on their own in about 2 weeks. You can still spread the infection to others as long as you have symptoms, because your stools carry the virus.

If you have been around someone who you know has hepatitis A, getting an injection of immune globulin (IG) within 2 weeks of exposure may prevent you from getting hepatitis A.

 

Home Treatment

Although no specific medical treatment is given for hepatitis A, home treatment can help relieve symptoms and prevent the spread of the virus.

Slow down
  • Reduce your activity level to match your energy level. Do not stay in bed, because that may slow your recovery. Listen to your body, and slow down when you become tired.
  • Don't go to work or school unless your workload can be decreased to match your energy level.
  • Avoid strenuous exercise.
  • As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.
Eat right
  • Even though food may not appeal to you, it is important for you to get adequate nutrition. Try eating small, frequent meals instead of three large meals. For most people, nausea and loss of appetite don't set in until later in the day. Try eating more in the morning and less later in the day.
  • Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.
Avoid dehydration

It is very important to keep your body well hydrated when you have hepatitis A, especially if you have been vomiting. Contact your health professional immediately or go to the nearest emergency room if you have vomited more than two times in one day.

  • Drink plenty of water.
  • If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories.
  • Many of the sports drinks available in grocery stores (such as Gatorade) can help replace essential electrolytes that are lost through vomiting.
Avoid alcohol and drugs

Hepatitis impairs your liver's ability to break down certain medicines and alcohol. If you take drugs (legal or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some medications can make liver damage worse.

Make sure your health professional knows all the medications you are taking, including herbal products. Do not take any new medications or stop taking existing prescription medications without your doctor's approval.

Talk to your health professional about when it is safe to drink alcohol in moderation.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control the itching. Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects.

Tell your health professional before you start any new medicine.

Tips to prevent the spread of hepatitis A

If you have been infected with HAV, there are steps you can take to avoid infecting the people you are in close contact with.

  • Inform those you live with or have sex with that you have hepatitis A. They should ask their doctor whether they need a shot of immune globulin. If given within 2 weeks of possible exposure to the virus, immune globulin (IG) is effective in preventing hepatitis A or reducing its symptoms. For more information, see the Medications section of this topic.
  • Wash your hands with soap and hot water immediately after using the toilet or changing a diaper and before preparing food.
  • Avoid any anal contact with a sex partner while you are infected

 

Medications

Although no medication can treat HAV symptoms after they develop, the hepatitis A vaccine is the most effective means of preventing hepatitis A virus (HAV) infection. The vaccine provides 94% to 100% protection if you receive both of the shots in the vaccination series.5 However, the vaccine may not be as effective in those with weakened immune systems, such as people who have human immunodeficiency virus (HIV).5

If you are not protected against HAV infection-either by vaccination or by previous exposure to the virus-and you have had close personal contact with someone who has hepatitis A, you should receive a shot of immune globulin (IG). IG is more than 85% effective in preventing HAV infection if you get it within 2 weeks of being exposed to the virus.5

IG is also recommended for:

  • People who are known to be allergic to other vaccines containing the same ingredients found in the hepatitis A vaccine.
  • Children younger than age 1 who have not been immunized with the hepatitis A vaccine and have been exposed to HAV, particularly children who spend time in day care centers.
Medication Choices
Hepatitis A vaccine
Immune globulin

For more information about the hepatitis A vaccines, see the Prevention section of this topic.

What To Think About

Immune globulin has been effective in controlling some outbreaks of the hepatitis A virus.

 

Surgery

Hepatitis A is a viral infection, so no surgical treatment is used.

A very small number of people, most often people with long-term (chronic) liver disease or older adults, develop liver failure when they become infected with the hepatitis A virus. This condition, called fulminant hepatitis, is life-threatening. For some people who have it, a liver transplant offers the only hope for survival.

 

WebMD Medical Reference from Healthwise

Last Updated: November 15, 2006

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

@ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

External Link:

http://www.webmd.com/hepatitis/hepa-guide

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