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.
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.
Our approach to viral hepatitis
UCSF offers the most advanced diagnostic and treatment options for patients with all forms of viral hepatitis. Our approach depends on the type and severity of the disease. Hepatitis A usually resolves on its own, so we help patients manage their symptoms and avoid spreading the infection. We treat chronic cases of hepatitis B or C with the latest medication therapies.
Chronic hepatitis infections can lead to severe liver damage or failure if patients don't respond to treatment or don't know they have the virus until symptoms of liver disease appear. In these cases, a liver transplant may be necessary. Our liver transplant program, designated a center of excellence by the U.S. Department of Health and Human Services, is known for outstanding outcomes and for helping pioneer techniques that have made transplants safer and more successful. We perform more than 200 transplants each year, and our survival statistics are among the very best in the country.
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Signs & symptoms
As viral hepatitis becomes more advanced, it may cause one or more of the following symptoms:
- Loss of appetite
- Nausea and/or vomiting
- Dark urine
- Stomach pain
- Yellowing of the skin and eyes, called jaundice
- Mood change, forgetfulness
- Black bowel movements, which indicate bleeding into the intestine
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.
Hepatitis A treatment
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.
Hepatitis B treatment
About 25 percent of people with chronic hepatitis B can be cured with a drug called 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 health care workers and sexual partners of infected persons, an effective vaccine exists and is recommended. In addition, transmission of hepatitis B from mother to newborn largely can be prevented by vaccinating the infant and administering hepatitis B immune globulin.
Hepatitis C treatment
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 the 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 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 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 patients who feel well 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.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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