Hepatitis – Types, Causes, Treatment and Prevention

Definition

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

Timeline

8th Century:  Infectious Nature of HBV suggested

17th-19th Centuries:  Outbreaks of epidemics of jaundice in military and civilian populations during wars

1883:  Lurman reports outbreaks of serum hepatitis follwing vaccination of dockers

1908: McDonald postulates that the infectious jaundice is caused by a virus

1939-1945: WWII-A series of outbreaks after vaccination for measles and yellow fever

1947: MacCallum classifies viral hepatitis into two types-

• Viral hepatitis A—> Infectious hepatitis
• Viral hepatitis B—> Serum hepatitis

1965: Blumberg discovers Australia antigen (HBsAg) in aborigines and shows presence of antigen

at high frequency in patients with leukemia and children with Down’s syndrome

1970: Dane discovers the Dane particle (complete HBV particle)

1972: Discovers HBeAg

1973: Feinstone and Purcell identifies HAV

1977: Rizzetto describes delta antigen HDV

1983: Recovery of HEV

1988: Chiron group (Choo, Kuo, Houghton) closes and identifies HCV.

1995: Abbot group reports GB Virus-C (GBV-C) and Genelabs group reports in 1996 hepatitis

G virus (HGV)—GBV-C=HGV

1996: Chang’s group at NTUH reports in JAMA the successful prevention of HBV infection by

nation-wide vaccination on newborn babies launched in 1984 in Taiwan.

1997: Chang’s group at NTUH reports in NEJM a decrease in annual incidence rate of

hepatocellular carcinoma in children ascribed to nation-wide vaccination against HBV on

newborn babies launched in 1984 in Taiwan.

Epidemiology

Globally, viral It was the seventh leading cause of death in 2013, up from the 10th leading cause in 1990. Worldwide, HAV is responsible for an estimated 1.4 million infections annually.  About 2 billion people in the world have evidence of past or current HBV infection, with 240 million chronic carriers of HBsAg. HBV, along with the associated infection by the hepatitis D virus, is one of the most common pathogens afflicting humans. HBV leads to 650,000 deaths annually as a result of viral hepatitis–induced liver disease.

The worldwide annual incidence of acute HCV infection is not easily estimated, because patients are often asymptomatic. An estimated 71 million people are chronically infected with HCV worldwide.  About 55-85% of these people infected progress to chronic HCV infection, with a 15-30% risk of developing liver cirrhosis within two decades.  China, the United States, and Russia have the largest populations of anti-HCV positive injection drug users (IDUs). It is estimated that 6.4 million IDUs worldwide are positive for antibody to hepatitis B core antigen (HBcAg) (anti-HBc), and 1.2 million are HBsAg-positive.

Types and causes

Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.

Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

Hepatitis A

Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B

Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.

It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C

Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection.

Hepatitis D

Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E

Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC.

Autoimmune Hepatitis

Autoimmune hepatitis is a rare form of chronic hepatitis. Like other autoimmune disorders, its exact cause is unknown. Autoimmune hepatitis may develop on its own or it may be associated with other autoimmune disorders, such as systemic lupus erythematosus. In autoimmune disorders, a misdirected immune system attacks the body’s own cells and organs (in this case the liver).

Symptoms of Hepatitis

When symptoms occur, they can include:

• Jaundice (a yellowing of the skin and eyes)
• Abdominal pain
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Fever
• Clay-colored bowel movements
• Painful joints

Yellowing of skin and eye

Complications of Hepatitis

Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:

• Chronic liver disease
• Cirrhosis
• Liver cancer

When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:

• Bleeding disorders
• A buildup of fluid in your abdomen, known as ascites
• Increased blood pressure in portal veins that enter your liver, known as portal hypertension
• Kidney failure
• Hepatic encephalopathy , which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function
• Hepatocellular carcinoma, which is a form of liver cancer
• Death

People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.

Diagnosis and test

History and physical exam

To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

Liver function tests

Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.

Other blood tests

If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.

Ultrasound

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:

• Fluid in your abdomen
• Liver damage or enlargement
• Liver tumours
• Abnormalities of your gallbladder

Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.

Liver biopsy

A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.

This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.

Treatment and medications

Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.

Hepatitis A

Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea , follow your doctor’s orders for hydration and nutrition.

The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.

Hepatitis B

Acute hepatitis B doesn’t require specific treatment.

Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.

Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines are typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis C

Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.

People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

Currently, there is no vaccination for hepatitis C.

Hepatitis D

No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people.

Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop.

Hepatitis E

Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.

Autoimmune hepatitis

• Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.
• Azathioprine ( Imuran ), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids.
• Other immune-suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.

Foods to eat

While most people with hepatitis C do not require a special diet, there are certain foods people can eat to maintain good liver health.

Fruit and vegetables

Dark green leafy vegetables in the marketplace, including kale, cabbage, and spinach.
Green leafy vegetables, including kale, cabbage, and spinach, may be particularly beneficial for people with hepatitis C.

A healthful and balanced diet should include plenty of fruit and vegetables. These food groups are full of necessary vitamins and minerals that enable the liver to function properly.

Fresh fruit and vegetables are ideal, but they can also be frozen or canned. People should aim to consume at least 5 portions of fruit and vegetables a day.

Leafy green vegetables can lessen fatty acid composition in the liver, so they are particularly beneficial to people with hepatitis C. Good examples include kale, spinach, and cabbage.

Leafy green vegetables are sources of iron, which may be harmful to those with hepatitis C when consumed in excess. While it is unlikely a person would eat enough leafy greens to cause iron overload, people with liver damage may wish to monitor their intake. A doctor or dietitian can help a person determine the right amount for them.

Protein

Getting adequate amounts of protein is important, as it provides energy and can keep a person feeling full. Replacing a portion of simple carbohydrates with protein is a good way to reduce the risk of conditions such as diabetes.

Good sources of protein include:

• Turkey
• Fish
• Tofu
• Eggs
• Cheese
• Beans
• Nuts and seeds

Dairy products also provide protein, calcium, and vitamin D. Low-fat or fat-free versions of dairy are the best choices for people with hepatitis C. People should limit dairy products with added sugar.

Complex carbohydrates

Cereals, bread, and grains are all examples of complex carbohydrates and are packed with B vitamins and minerals, as well as zinc and fiber.

Complex carbohydrates include:

• Brown rice
• Oatmeal
• Whole oats
• Whole Rye
• Whole Wheat
• Wild rice

Prevention of Hepatitis

There are many steps you can take to reduce the risk of viral hepatitis:

• Consider getting vaccinated against hepatitis A and B if you weren’t vaccinated as a child. This is the number one way to prevent these illnesses.
• Wash your hands with soap and water after using the bathroom or changing a baby’s diaper and before handling food.
• When traveling in developing countries, avoid unpeeled or raw foods. Drink only bottled, boiled or chemically treated water.
• Practice safe sex. Hepatitis B is about 50–100 times more transmissible during sex than HIV. Condoms and other barrier methods greatly reduce the risk.
• Never share syringes, shaving razors, toothbrushes or tattooing or piercing supplies.
• Wear gloves when performing first aid.
• Disinfect blood spills (including dried ones) with diluted bleach and wear gloves during clean-up.
• Follow all occupational safety precautions in your workplace.
• If you are pregnant, seek early and regular prenatal care.

To reduce the risk of non-viral hepatitis, avoid excessive alcohol consumption and consult with a healthcare professional about medications and supplements.