What is Hepatitis?
The word Hepatitis means inflammation of the liver. It comes from the Greek word, ‘hepar’ meaning liver and Latin ‘itis’ meaning inflammation. So hepatitis means inflammation of the liver cells or liver damage. It may be caused by viruses, alcohol, drugs or other toxins. It is the transmission and spread of these viruses that causes major population health risks. Five known viruses can cause viral hepatitis. These are hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E. Although they produce similar symptoms, their modes of transmission are different as is the severity of damage that they can do to your liver. Hepatitis can be an acute illness, which although severe lasts for a short duration, or it can be chronic which means that it can last for a long time, often for most of the person’s life leading to the possibility of severe liver damage . However, not all types of hepatitis are infectious. Alcohol abuse, prolonged medication with certain drugs, chemicals and even obesity can lead to liver injury.
How does Viral Hepatitis affect my liver?
Hepatitis viruses which become chronic infections have the potential to damage liver cells. As injury to the liver increases, scar tissue develops which is known as fibrosis. Severe fibrosis hardens the liver and prevents it from functioning normally. This is known as cirrhosis.
What are the symptoms of hepatitis?
Some people with hepatitis may present no symptoms at all while others may report loss of appetite, nausea and vomiting, diarrhoea, dark urine or pale stools, stomach pain and jaundice.
Tell me more about the different types of Viral Hepatitis
Hepatitis A is a contagious liver disease caused by the Hepatitis A virus (HAV). This infection is spread through the faecal –oral route which happens when we consume contaminated food or drink. Most at risk are travellers in developing countries where food and water contamination is a big problem. Hepatitis A vaccines are available which can be given to children above one year of age. Practicing good hygiene and sanitation are important ways to prevent transmission of this virus. Hepatitis A normally resolves on it’s own after a few weeks and the individual will be immune to the virus for the rest of his life.
Hepatitis B or HBV infection can be spread through blood or serum or by sexual contact with an infected person. Infected mothers can pass it on to their newborns. Patients with Hepatitis B are at risk of developing cirrhosis, liver failure or liver cancer.
The symptoms of Hepatitis B can range from none to minimal in the early stages. These can include jaundice, nausea, vomiting, fevers, abdominal pain dark urine and pale stools. The majority of adults who contract Hepatitis B will clear the infection by themselves and not need medical treatment. However, some people who develop chronic Hep B (when the virus remains active within the liver over six months) may require treatment because chronic carriers are at risk of developing cirrhosis or hepatocellular carcinoma.
People with chronic Hepatitis B will need to have blood tests and possibly a liver biopsy to assess the extent of damage to the liver. Pegylated Interferon, Lamivudine, Adefovir and Entacavir are the drugs approved in Australia. Sometimes when treatment for Hepatitis B commences, liver inflammation may get worse for a while. This is known as a Hep B flare. After a while, however, this should resolve and the patient should be able to clear the virus as the medication takes effect.
Those at greatest risk of Hepatitis B are intravenous drug abusers, people with multiple partners, homosexual men, health care workers and people from China and South East Asia where Hepatitis B is more prevalent.
With proper immunization Hepatitis B is a completely preventable disease.
In today’s world Hepatitis C (HCV) is a huge health challenge. It is one of the most chronic viral ailments affecting Australians. Hepatitis C is transmitted almost exclusively via contaminated blood. The main instruments for spread are contaminated needles and syringes. There is no vaccine available yet for Hepatitis C.
Living with Hepatitis C
Living with hepatitis C can be hard because there are many misconceptions and prejudices surrounding Hepatitis C. This makes it as much a social issue as a medical one. Hepatitis has been the cause of liver disease for many decades. It has been found in blood stored during the Second World War in the 1940’s. Blood transfusions, inadequate sterilizations and use of non disposable syringes contributed towards the first wave of HCV epidemic post World War II. It was only in the 1990’s that screening for Hepatitis C was made compulsory. However, a second wave of Hepatitis C epidemic occurred in the 80’s and 90’s because of injecting drug use.
Hepatitis C is an infective disease, and until recently there was no definitive cure. So people tended to be wary of those suffering from Hepatitis C. Although today hepatitis C can be completly cured, the stigma remains. Fear and ignorance about Hep C makes us shun those living with the disease. This can cost people their jobs, relationships and friends. People tend to judge a Hepatitis C positive person as having been a drug user where in fact the person may not have touched drugs ever. This social stigma often has negative consequences on the patient, lowering their self esteem and filling them with a fear of disclosing their positive status.
Educating the public is the only way to break this stigma. It is perfectly safe to sit next to, hug, kiss or shake hands with an infected person.
Symptoms of Hepatitis C
Initial infection with hepatitis C can be asymptomatic although acute hepatitis can occur in 25% of cases. While the infection resolves in some people, more often than not it continues and eventually causes liver damage. Interestingly, most people with Hepatitis C are not even aware that they are infected because it causes no symptoms. It is a slowly progressive, inflammatory, fibrosing liver disease that can extend from anywhere between two to six decades.
Transmission of Hepatitis C
For the Hepatitis C virus (HCV) to spread from one person to another, it must enter through the blood stream via blood from an infected person. Prior to 1990 people could have been infected with Hepatitis C when they received blood or blood products. The Australian Red Cross Blood Bank now screens all donated blood and blood products for Hepatitis C virus and antibodies. Transmission of Hepatitis C can also occur via tattoos and piercings and by injecting drugs using contaminated apparatus.
Treatment of Hepatitis C
Hepatitis C becomes contagious with the presence of anti HCV antibodies in the blood or when the HCV RNA or HCV core antigen is detected in the blood. However, all Hepatitis C patients should be considered potentially infectious. Such persons should take care never to donate blood, semen, tissue or organs. They should also take care not to share toothbrushes and razors and keep any open cuts or bruises covered so as not to infect other people. Treatment options for Hepatitis C include Alpha interferons in combination with Ribavirin. Not all patients respond suitably to this treatment because there are other clinical factors which decide this outcome. The alpha interferon is a host protein that is made in response to viral infections. This stimulates natural antiviral immune activity in a person to inhibit viral growth and replication. Interferon focuses on suppressing the Hepatitis C virus by increasing the immune response against it. Ribavirin is an anti viral drug which is active against many kinds of viruses. Although by itself it has little effect on the Hepatitis C virus, in combination with Pegylated Interferon ( a long acting alpha interferon) it increases the sustained response (or cure) in an individual drastically. However, there can be quite a few adverse effects of this combination therapy so patients who are on this treatment are monitored regularly. Interferon is known to have a negative effect on mood and concentration and it can lead to irritability and depression. In fact, patients with a history of severe depression or bi polar disorders will not be offered this therapy. Ribavirin can cause minor side effects like rash or upper respiratory tract congestion. Patients on treatment with Ribavirin are warned to use adequate contraceptive methods because of its known teratogenicity (i.e. it could cause malformations to the embryo or foetus).
Hepatitis D is also known as the Delta virus. This virus can only be present in the presence of Hepatitis B virus which means that only people infected with Hepatitis B can have Hepatitis D. This form of hepatitis is not very common in Australia. The symptoms of Hepatitis D are similar to Hepatitis B and include loss of appetite, nausea, vomiting, jaundice, abdominal pain, fatigue, dark urine and pale stools. Alternatively, like Hepatitis B, there may be no symptoms at all. Hepatitis D is spread in similar ways to Hepatitis B. A blood test will reveal if you are a carrier of Hepatitis D. Vaccination for Hepatitis B will automatically prevent Hepatitis D.
Hepatitis E infection, like Hepatitis A , is a waterborne disease that is transmitted via the faecal oral route. This infection is found more commonly in developing nations like India, Asia, Africa and Central America. The highest incidence of Hepatitis E can be seen in areas where sanitation is poor, and faecal contamination of drinking water is common. Hepatitis E causes an acute short term illness and clears by itself. It does not lead to chronic long term infection. There are no vaccines yet available for Hepatitis E. Prevention is the best cure in this scenario.