Viral Hepatitis

Signs and Symptoms

As viral hepatitis becomes more advanced, it may cause one or more of the following symptoms:

• Loss of appetite
• Nausea and/or vomiting
• Fever
• Dark urine
• Stomach pain
• Fatigue
• Yellowing of the skin and eyes, called jaundice
• Mood change, forgetfulness
• Black bowel movements, which indicate bleeding into the intestine

Diagnosis

In making a diagnosis of hepatitis, blood tests are performed to detect the hepatitis virus, as well as the antibody to the virus. The tests also distinguish between an acute or chronic infection.

Treatment

Treatment for hepatitis varies, depending on the type and severity of the disease.

• Hepatitis A -- There is no specific therapy for acute hepatitis A infection. Therefore, prevention is the key. An effective vaccine is available and recommended for anyone with liver disease. It also is recommended for people planning travel to areas of the world where sanitation may be less than optimal. Before administering the vaccine, the patient usually will have a blood test to check whether antibody to the virus is present already, in which case vaccination is unnecessary.

• Hepatitis B -- About 25 percent of individuals with chronic hepatitis B can be cured with the drug, pegylated interferon-alpha, which is taken as a weekly injection for six months. The alternative is suppression of the virus with oral medications, such as lamivudine and adefovir. Suppression is recommended for patients with elevated viral levels and evidence of advancing liver disease. In people with a possible exposure to hepatitis B, such as healthcare workers and sexual partners of infected persons, an effective vaccine exists and is recommended. In addition, transmission of hepatitis B from mother to their newborn largely can be prevented by vaccinating the infant and administering hepatitis B immune globulin.

• Hepatitis C -- Currently, the most effective therapy for hepatitis C is a drug combination consisting of pegylated interferon and ribavirin. Pegylated interferon is taken weekly as an injection and ribavirin is a twice daily tablet. The treatment is a form of chemotherapy and the ability to tolerate it varies widely for each person. A patient's response will depend on their particular type of hepatitis C, known as the "genotype." In the U.S., genotypes 1, 2 and 3 account for most cases. Interferon-ribavirin cures about 40 percent of genotype 1 cases and 80 percent of cases with genotype 2 or 3. Other factors that improve a patient's chances of cure include low viral level, normal liver function and normal weight.

  In most people, interferon-ribavirin causes flu-like symptoms with muscular aches, irritability, loss of appetite and depression. Rashes and hair loss also may occur. Interferon and ribavirin both reduce blood cell counts, which may require dose reduction or discontinuation of treatment. Regular laboratory testing during the treatment is essential. Some people find that they cannot continue to work on this regimen, which lasts either 48 weeks for genotype 1 or 24 weeks for genotypes 2 and 3. Finally, the cost of the medication is high, making insurance coverage essential.

Liver Transplantation

The UCSF Liver Transplant Program, which integrates the efforts of gastroenterologists and surgeons, performs over 100 transplants each year, making it one of the leading programs in the U.S. Survival statistics are among the very best in the country. Liver transplant may be an option for people whose hepatitis progresses to liver failure and who fail to respond to treatment or cannot tolerate treatment. Currently, almost one half of all liver transplants in the U.S. are performed for end-stage hepatitis C. The evaluation for a transplant is complex and generally requires several months. Therefore, even if a patient is feeling well, they should be referred for a transplant at the first sign of liver failure or if they have advanced liver disease diagnosed by X-ray studies or liver biopsy.