What is viral hepatitis?

Viral hepatitis is an inflammation of the liver caused by one of several viruses: hepatitis A, B, C (formerly known as non-A, non-B), D, E and G. Things other than viruses can also cause hepatitis or inflammation of the liver. One cause is autoimmune hepatitis.

What is autoimmune chronic active hepatitis?

The body's own immune system, for unknown reasons, attacks the liver cells often leading to chronic active hepatitis and cirrhosis. Some patients require treatment with corticosteroids, which suppress the overactive immune response. This disease is not infectious although it is called "hepatitis." It is most common in young women, but can be found in all age groups, as well as men.

Hepatitis A (HAV)

Eating food or drinking water that has been contaminated with human waste - called the fecal-oral route of infection transmits Hepatitis A. Infections with the hepatitis A virus are always acute (except in rare instances) - patients can clear the virus from their bodies within three to four months, without risk of long-term liver damage. A vaccine is available for the prevention of hepatitis A.

The Centers for Disease Control and Prevention (CDC) lists household or sexual contact, day care attendance or employment, and recent international travel as the major known risk factors for becoming infected with this virus. Food handlers and those who have used contaminated needles are also at risk.

Given that most all infections with HAV are acute, medical treatment is not needed to eliminate the virus. However, doctors may prescribe medicine to treat symptoms of hepatitis, such as headache and nausea, or they may give patients IV fluids to prevent dehydration. Patients can usually recover at home. Avoiding alcohol is the common recommendation, because, as a toxic substance, alcohol greatly weakens an already damaged liver.

Some people with HAV may not have any symptoms, especially children under two years old. In most cases, however, people experience "flu-like" symptoms, including fatigue and nausea with vomiting, and pain in the liver area. Less common symptoms are dark urine, light-colored stools and fever.

Hepatitis B (HBV)

The hepatitis B virus, a serious form of hepatitis, is spread through contact with infected blood. It is more common and much more contagious than HIV (the virus responsible for AIDS). There are about 1.2 million people in the U.S. with hepatitis B. Most adults can fight off an infection without treatment. However, HBV may develop into a chronic form in up to 10% of patients. If chronic HBV is left untreated the risk of developing cirrhosis and liver cancer increases. A vaccine is available for the prevention of hepatitis B.

Because HBV is a blood-borne infection, it is spread in many ways. Just the tiniest amount of blood on common, everyday objects, like a toothbrush, razor or manicure instrument can carry enough of the virus to infect someone. Here are the major ways that hepatitis B is spread:

• Hemodialysis patients (using kidney machines)
• Jobs with exposure to blood (especially healthcare workers)
• Unprotected sex with an infected partner
• Tattoos and body piercing
• Sharing straws for inhaling cocaine
• Sharing person care items (such as nail files and nail clippers)
• Sharing needles for IV drug use

Additionally, people traveling to countries where the hepatitis B virus is known to be endemic (common) are at risk. Pregnant women can also pass the virus to their babies.

Some people with HBV have no outward signs or symptoms. But others do experience "flu-like" symptoms, such as fatigue, loss of appetite, nausea and vomiting, fever, weakness and mild abdominal pain. Less common symptoms are dark urine and yellowing of the skin and eyes (jaundice).

If patients have been infected with HBV for six months ore more, their doctors may feel they need treatment in order to avoid permanent liver damage. In addition to treatment, patients may also receive a vaccination for the prevention of hepatitis A.

Currently, there are four approved treatment modalities in the United States, interferon, lamivudine, adefovir dipivoxil, and entecavir. Interferon is an injectable medication that has limitations. Lamivudine, Adefovir, and Entecavir are oral medications. Lamivudine’s major drawback is the strong likelihood of development of mutation in the hepatitis B virus allowing it to escape the viral suppressive effects of lamivudine. This occurs in up to 66% of patients after four years of therapy. For this reason, Adefovir is becoming the treatment of choice in patients with chronic hepatitis B infection. Interferon offers a benefit of treatment in the fact that it has a 30-to-40% seroconversion rate of hepatitis B e antigen (HBeAg) to hepatitis B e antibody (HBeAb). The durability of this response appears to be 80-to-90% in patients after four-to-eight years of follow-up.

Seroconversion, i.e.-e antigen to e antibody, is preferable to just e antigen loss alone. Furthermore, with oral medications, durability of e antigen seroconversion may be affected by the duration of treatment after e antigen seroconversion. Thus, data supports the continuation of treatment with oral preparations for at least four-to-six months after e antigen seroconversion (lamivudine or adefovir or entecavir).

For an in depth discussion, please visit the "Guest Column" section and review the Hepatitis B articles by Drs. Galati and Monsour and by Dr. Hoefs.

Hepatitis C (HCV)

The most serious form of hepatitis, hepatitis C currently affects over four million Americans. About 85% of all infections develop into chronic infections. If left untreated, there is a high chance of cirrhosis, liver failure and liver cancer. Liver failure due to hepatitis C is now the leading cause of liver transplants in the United States.

Hepatitis C is easily spread by blood. There are many ways of being in contact with blood, and this includes blood from cuts, nosebleeds, or even menstrual blood. The major ways that hepatitis C is spread are:

* Blood transfusion before 1992
* Hemodialysis patients (using a kidney machine)
* Jobs with exposure to blood (especially healthcare workers)
* Tattoos and body piercing
* Sharing straws for inhaling cocaine
* Sharing personal care items
* Sharing needles for IV drug use
* Unprotected sex with multiple partners
* Infected mothers have approximately 6% chance of passing the virus to their newborns. This risk increases with a concurrent HIV infection.
* In about 10% of people with HCV the mode of transmission is unknown

What are the symptoms of Hepatitis C?

Most people who have HCV do not know they have the illness and are free of any symptoms. Interestingly, in many people, the presence of symptoms does not bear any relationship with the extent of the illness. In other words, someone with very mild HCV can describe many of the symptoms, while another person who has much more advanced disease may not have any symptoms of HCV. Some of the more common symptoms include extreme fatigue, itching and joint pain.

How do I know if I have Hepatitis C?

Usually, people with HCV are discovered because the liver enzymes in their blood are above normal limits, and their doctors do more blood tests to find the cause. Others are found through testing positive while donating blood.

Because HCV-infected individuals may be free of symptoms and unaware of any illness, they should take any number of available Risk Assessment Tests. The tests are to determine who may be at risk for the disease. If someone is considered to be potentially at risk, he or she should see a doctor and have their blood tested for HCV.

Hepatitis D

Hepatitis D, or delta virus, enters cells by binding to a piece of hepatitis B virus. It acts like a hitchhiker and infects only people who either are actively infected with hepatitis B or are chronic carriers of hepatitis B. It is rather like a parasite. It also leads to persistent infection and is more common in people who have acquired hepatitis B through intravenous drug use rather than other routes of transmission.

Hepatitis E

Hepatitis E is another viral cause of liver inflammation that is more common in the developing world than in the United States. This hepatitis virus is also transmitted predominantly by ingesting feces tainted with hepatitis E. Most cases consist of an acute hepatitis from which people recover fully. It can run a more aggressive course in pregnant women. Hepatitis E is very rare in the U.S. and is responsible primarily for an acute form of hepatitis in travelers returning from endemic areas such as Africa.

Hepatitis G

The best evidence available now, and these things can change, is that hepatitis G is a benign agent which hangs around in people's blood and liver. It is not linked to any concrete disease. Therefore, no routine screening is done for hepatitis G nor are there treatments developed to eliminate it.