Several distinct viruses can infect the liver, causing inflammation that is called hepatitis. The most prevalent of these in the United States are hepatitis A, B and C.
Experts at UCSF Medical Center offer the most advanced diagnostic and treatment procedures for patients with all forms of viral hepatitis. If the condition progresses, resulting in severe liver damage or liver failure, or if a patient does not respond to treatment, a liver transplant may be necessary. The UCSF Liver Transplant Program performs more than 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.
Hepatitis A is acquired from contaminated food or water. In healthy individuals, it causes an acute illness with fever, loss of appetite and jaundice lasting two to three weeks. Complete recovery is the rule, followed by life-long immunity to the virus. In people with pre-existing advanced liver disease, acute hepatitis A tends to be severe and can be fatal.
Acquired through exposure to the blood or secretions of an infected person, hepatitis B also can be transmitted through sexual contact. Newborns may acquire it at the time of birth from a mother with active hepatitis B.
Adults who contract hepatitis B have an acute illness that ranges from very mild, with flu-like symptoms only, to nausea, abdominal pain and jaundice.
Most people with the condition recover and develop immunity, but 5 percent to 10 percent become persistently infected, and have the potential to infect others. For infants who are exposed at birth and do not receive treatment, the rate of chronic infection is much higher. People with long-standing active hepatitis B, spanning more than 20 years, are at risk of developing liver cancer.
Currently the main mode of transmission of hepatitis C is through injecting illicit drugs using needles from infected persons. Prior to the testing of banked blood, the disease was passed through transfusions. Unlike hepatitis B, the rate of sexual transmission is low.
The acute illness is frequently very mild. However, many people fail to clear the virus, such that about 70 percent become chronically infected. An estimated 4 million Americans have hepatitis C, many of whom are unaware of their condition.
The virus causes inflammation that slowly and insidiously, over a period of 20 to 30 years, leads to scarring of the liver. As the disease progresses, the first sign may be nothing more than decreased energy. As the liver disease becomes significant, patients may experience retention of fluid, causing swelling of the ankles and increased weight, internal bleeding and confusion. The rate of disease progression is variable, for reasons that are only partially understood. It is clear that heavy alcohol use accelerates the pace of disease. In people who develop advanced scarring of the liver, a condition known as cirrhosis, the risk of developing liver cancer is significant.
As viral hepatitis becomes more advanced, it may cause one or more of the following symptoms:
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 for hepatitis varies, depending on the type and severity of the disease.
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 to travel to areas of the world where sanitation may be less than optimal.
Before receiving 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.
Reviewed by health care specialists at UCSF Medical Center.