Still in time to participate in Hepatitis Awareness Month (May), Women’s Voices for Change presents this overview, by Brian Landzberg, M.D., of the causes of—and treatments for—liver disease. Dr. Landzberg, a gastroenterologist,  is a member of WVFC’s Medical Advisory Board. —Ed.

What is hepatitis? The prefix “hepa” refers to the liver, while the suffix “itis” refers to inflammation. The CDC created the awareness month to focus on infectious, or viral, hepatitis, because most people with chronic hepatitis (B or C) are unaware of their infected status, putting them at risk of progressive liver disease and liver cancer—and of spreading the infection to others.

Although the focus this month has been on viral hepatitis, recall that other forms of liver inflammation do exist, such as alcoholic liver disease, non-alcoholic steatohepatitis (inflammatory fatty liver disease), autoimmune hepatitis, et al.

The viral hepatitides are named by a letter from A to E, and this article will very briefly discuss them.  Other viruses, such as Epstein-Barr and Cytomegalovirus (agents which cause infectious mononucleosis), can also cause an acute hepatitis, but we will focus on the liver-specific viral infections here.

Hepatitis A

Hepatitis A is generally an acute infection only, with chronic [long-term] infection extremely rare. It usually presents with a flu-like viral syndrome and liver blood test abnormalities. Hepatitis A is transmitted by fecal-oral spread, i.e., by eating or drinking food (often fruits, vegetables, shellfish) contaminated by stool containing hepatitis A virus, contact with the stool or blood of a person, poor hand-washing or sexual practices that involve oral-anal contact. About 3,600 cases of hepatitis A are reported yearly.

Risk factors include international travel, living in a nursing home or rehabilitation center, or working in the health care, food, or sewage industry. There is no antiviral treatment, but generally none is necessary, since it is a self limited disease. Eighty-five percent recover within three months, and almost all patients get better within six months. There is an extremely low risk of death, but this is higher among the elderly and chronic liver-disease patients. One in a thousand may develop life-threatening fulminant hepatitis. A vaccine is available for prevention and should be considered, especially for travelers and patients with chronic liver disease.

Hepatitis B

Hepatitis B may present clinically as either an acute hepatitis with jaundice (yellow eyes and skin) or chronic liver disease, the latter with either asymptomatic liver blood test abnormalities or, in late stage, signs of cirrhosis such as confusion, gastrointestinal bleeding, fluid in the abdomen, jaundice, and weight loss. Most patients who get acute hepatitis B do clear it and do not go on to have chronic hepatitis. More than a million Americans are chronically infected, and areas in Asia and Africa have much higher prevalences.

It can be spread through contact with blood, semen, or vaginal secretions, and is usually spread either mother-to-baby, through sexual contact, or through needle drug use.  Sharing razor blades and toothbrushes is another risk factor, but food, hugging, kissing, and casual contact do not transmit hep B. This is a disease we need to screen for, because effective antiviral medications do exist, either in the form of injected interferon or oral antiviral agents.

Sources of hepatitis infection. (Source: Centers for Disease Control)

The decision whether or not to treat and which drugs to use is complex and is generally left to either gastroenterologists/hepatologists or infectious disease experts, but the key is to identify the disease in a preclinical form—before signs of liver deterioration or liver cancer develop. It is particularly important to screen pregnant patients for hepatitis B, because the risk of transmission to the baby can be greatly reduced with treatment.

Hepatitis C

Hepatitis C is spread through similar routes as hepatitis B, but differs in that the acute acquisition is usually clinically invisible and the majority of those affected will go on to chronic hepatitis. Approximately 3 million people in the United States are infected with hepatitis C. Like hepatitis B, good antiviral therapies exist, and the key is early detection and attempt to cure the virus before signs of chronic liver disease develop. The mainstays of treatment are weekly injectable pegylated interferon, combined with oral ribavirin and potentially one of the newly approved drugs, telaprevir or boceprevir. Unlike hepatitis B, there is no vaccine for hepatitis C.

Hepatitis D, Hepatitis E

Hepatitis D is a rare case of hepatitis that can occur only in patients who are also infected with hepatitis B. The viral agent that causes hepatitis D depends on using parts of the hepatitis B virus to survive.  Hepatitis E, like hepatitis A, is an acute infection only, spread through the fecal-oral route.  It occasionally affects Americans who travel to endemic areas, including Africa, India, and Mexico.  Pregnant women have a very increased risk of fulminant hepatic failure from this infection, with an estimated 20 percent mortality, and should be warned about traveling to countries where the infection is endemic.

I hope this article has served as a helpful and very brief overview of a very vast topic.  For those interested in learning more, I would recommend the CDC website.

 

 

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