WHAT IS HEPATITIS?

Hepatitis is an inflammation of the liver and has a variety of causes.  The most frequent cause is infection by a virus (viral hepatitis).  There are several viruses that cause hepatitis, however, the most frequently encountered ones are called Hepatitis A (HVA), Hepatitis B (HVB) and Hepatitis C (HVC).

Your Wonderful Liver

Before we discuss the specific infections, let me mention just how important your liver is to your health.  Your liver is an extremely important organ that performs many functions.  It processes all of the nutrients for your body, including protein, glucose, and fat.  It removes old red blood cells and recycles the iron contained in them.  And it neutralizes toxins and other harmful substances in your blood.  This includes alcohol, nicotine, medications and byproducts of digestion. 

It’s difficult to locate a matching liver for a transplant and “artificial livers” just don’t get the job done.  Anything that damages your liver is very bad indeed.

Hepatitis A

Hepatitis A is caused by the Hepatitis A virus.  You usually catch Hepatitis A by ingesting feces-contaminated food or water.  This is not usually a problem in the United States, but traveling to any underdeveloped country will put you at high risk of being exposed to the virus.  Hepatitis A symptoms are often mild, but when more severe they include fever, tiredness, loss of appetite, nausea, dark urine, and “yellow jaundice,” which is a yellowing of the skin and eyes.

The illness usually goes away within 2 months, after which you are immune to further infection.  In rare cases there are serious complications which may result in death.  The severity of the symptoms and the chances of complications increase with increasing age. 

You are at risk for contracting Hepatitis A if you 1) eat food that has been prepared by someone infected with HVA who has poor hygiene, 2) eat raw or undercooked seafood (for instance, oysters) or 3) travel in foreign countries where the sewage system is poorly developed.  Generally, I recommend that all of my patients be immunized against Hepatitis A regardless of risk factors.

Hepatitis B

Hepatitis B is a serious sexually transmitted disease of the liver caused by the Hepatitis B (HVB).  Hepatitis B is primarily transmitted through exchange of blood and bodily fluids and can be passed from an infected mother to her newborn child.  It can be transmitted through needle sharing during illicit drug use and by improperly sterilized equipment used in tattooing.  Hepatitis B is the only sexually transmitted disease preventable via vaccine.

Like Hepatitis A, Hepatitis B symptoms are often subtle.  You might think that you only have a “stomach flu” or that you are just tired and need to take it easy for a few days.  When symptoms are more serious, they are similar to those caused by Hepatitis A.  Hepatitis B can cause serious liver disease such as life-long infection, cirrhosis of the liver, liver cancer, liver failure and death.

Most people recover from Hepatitis B in about 6 months after which they are immune to further infection.  However, about 6% of those infected after 5 years of age develop Chronic Hepatitis B (life-long infection).  This is a very serious condition requiring lifestyle change to prevent complications and to prevent spreading the disease to others.  Chronic Hepatitis B can be treated, however the treatment is prolonged, unpleasant and is only successful in about 60% of cases.

Those who have Hepatitis B should protect their remaining liver function by avoiding alcohol and getting vaccinated against Hepatitis A.

As I mentioned earlier, Hepatitis B is preventable.  In fact, states began requiring immunization of all school-aged children during the 1990’s.  However, most adults have not been immunized.  I recommend that all of my patients be vaccinated against Hepatitis B.  If infected, they should take care to not pass the virus to others by not sharing chewing gum, razors, washcloths, or anything else that may have come in contact with their blood or bodily fluids.  Personal items such as tissues, menstrual pads, and tampons should be disposed of in a sealed bag.  Sexual contact should be restricted to those who have been immunized against Hepatitis B or who are immune to further infection.

Those who forgo immunization should use condoms during sex unless in a monogamous relationship with a person proven not to be infected.

Hepatitis C

Hepatitis C is a serious liver infection caused by the Hepatitis C virus and is a common blood-born infection.  Hepatitis C is contracted by exposure to blood and other bodily fluids of an infected person.  The degree to which Hepatitis C can be transmitted through sexual contact is still under study, but it is currently believed to be relatively low.  Until blood screening for Hepatitis C began in 1990 the disease was spread primarily through blood transfusions.  In many cases, the method of transmission is undetermined, though it is often transmitted through needle sharing during illicit drug use or through improperly sterilized needles used for tattooing. 

Hepatitis C frequently shows few identifiable symptoms.  Symptoms usually appear one or two months after infection and are typically fatigue, loss of appetite, or “itchy skin.”  Most persons infected with Hepatitis C develop Chronic Hepatitis C—a life-long infection that can lead to cirrhosis of the liver and liver cancer.

There is no cure for Chronic Hepatitis C and there is no vaccine to protect against it.  There are, however, recently developed treatments still under investigation which decrease the damage to the liver may lead to a cure.  To prevent infection and transmission of Hepatitis C, follow the rules to prevent infection and transmission of Hepatitis B.

Hepatitis A and Hepatitis B Vaccines

Hepatitis A and Hepatitis B are preventable.  Vaccines are available to protect against Hepatitis A and Hepatitis B.  Unfortunately, many insurance plans do not cover vaccinations against HVA and HVB for adults.  Nevertheless, I strongly recommend to all of my patients that they ensure their immunity to these diseases by being vaccinated.  I especially recommend immunization for my single, sexually active patients.

Alice V. Coghill, M.D.

June, 2004