Category Archives: Hepatitis

Hepatitis

Hepatitis C Quick Facts

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What is hepatitis C?
Hepatitis C is a virus that causes acute (short-term) infections in some individuals, but in most individuals, the virus remains in the body causing serious chronic (long-term) infection (1).

How does hepatitis C spread?
Hepatitis C is usually transmitted through exposure to blood from an infected individual (1).

  • The most common way is through sharing needles
  • Other potential sources of infection include:
    • At birth (~6% of infants of infected mothers)
    • Sexual intercourse (rare but more common in men who have sex with men)
    • Healthcare exposures
    • Blood transfusions and organ transplants (now very uncommon)
    • Unregulated tattoos or body piercings
    • Sharing personal items that have been in contact with infected blood (e.g. glucose monitors, razors)

What are the symptoms of hepatitis C?
Many individuals with an acute hepatitis C infection remain asymptomatic and are unaware they are infected. However, it is still possible for viral transmission to occur even in the absence of symptoms. Symptoms may appear 2-12 weeks post-exposure and include:

  • Yellowing of the skin or eyes
  • Lack of appetite
  • Diarrhea and vomiting
  • Fever
  • Dark urine
  • Joint pain

More than 50% of infected individuals go on to develop a chronic infection (2), which again often doesn’t cause any noticeable symptoms at least for quite a long period.

Over several decades, mild to severe liver disease develops in most affected individuals, including cirrhosis and liver cancer (3).

Several factors increase the risk of the development of cirrhosis in infected individuals, including being male, >50 years, increased alcohol consumption, hepatitis B or HIV coinfection, and immunosuppressive therapy (3). Chronic HCV infection is a common reason for a liver transplant in the United States (4).

Due to a general lack of symptoms, often individuals infected with hepatitis C are only diagnosed through screening for blood donation or during a routine health check-up (1).

Who is at risk of hepatitis C?
Groups that have an increased risk of hepatitis C include:

  • HIV-positive individuals
  • Injectable drug users
  • Individuals on hemodialysis
  • Healthcare workers
  • Children born to hepatitis C-positive mothers

How is hepatitis C diagnosed?
Hepatitis C diagnosis is by laboratory analyses from a blood sample. The initial test detects antibodies that are produced by the immune system of an infected individual in response to the hepatitis C infection. The presence of these antibodies indicates that an individual has either a current or past hepatitis C infection. Additional testing to detect hepatitis C virus RNA is required to diagnose an active infection and determine the viral load.

How is hepatitis C treated?
Hepatitis C is treated with antiviral medications to eliminate the virus from the body. Newly developed “direct-acting” antivirals have improved hepatitis C treatment considerably with fewer side effects and shorter treatment periods. Nowadays, over 90% of infected individuals can be cured with 8-12 weeks of oral therapy (5).

Effective treatment slows down the progression of inflammation and scarring of the liver and reduces the chances of liver cancer. However, antivirals do not help repair any tissue damage that has already occurred.

References:
1. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
2. Liang TJ, Rehermann B, Seef LB, & Hoofnagle JH. (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med, 132(4), 296-305.
3. Thomas DL & Seef LB. (2005) Natural history of hepatitis C. Clin Liver Dis, 9(3), 383-398.
4. Definition & Facts of Liver Transplant. March 2017.
5. Initial Treatment of Adults with HCV Infection. August 2020.

Hepatitis

Hepatitis B Quick Facts

Posted on by dnaserver

What is hepatitis B?
Hepatitis B is a major global health problem that can cause both acute (short-term) and chronic (long-term) liver disease (1).

How does hepatitis B spread?
In regions of the world with the highest rates of hepatitis B, perinatal transmission (mother to child at birth) is the most common mode of transmission. Horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child under the age of five years is also common (1).

Hepatitis B can also spread through needle stick injury, tattooing, piercing, sharing drug needles and syringes, and other exposures to infected blood, saliva, vaginal, and seminal fluids. Sexual transmission can occur, with more common occurrences in men who have sex with men, heterosexuals with multiple sex partners, and sex workers (and their clients) (1).

What are the symptoms of hepatitis B?
Many individuals with acute hepatitis B remain asymptomatic and are unaware they are infected. However, it is still possible for viral transmission to occur even in the absence of symptoms. In symptomatic individuals, yellowing of the skin or eyes, nausea, vomiting, abdominal pain, dark urine, and fatigue can last several weeks or persist for up to six months (1).

In some individuals, hepatitis B can develop into a chronic infection. This is common in infants and young children but rare (less than 5%) in adults. Chronic hepatitis B can develop into cirrhosis or liver cancer (2). Symptoms can include:

  • Fatigue
  • Weakness
  • Lower leg swelling
  • Yellow skin
  • Fluid accumulation in the abdomen
  • Spider-like blood vessels on the skin
  • Nausea
  • Indigestion
  • Pain at the top right of the abdomen or in the right shoulder (referred pain)

Who is at risk of hepatitis B?
Groups that have an increased risk of hepatitis B include:

  • Children of hepatitis B-positive mothers
  • Individuals who frequently require blood or blood products
  • Dialysis patients
  • Incarcerated persons
  • Injectable drug users
  • Close contacts of hepatitis B-infected individuals
  • Individuals with multiple sexual partners
  • Healthcare workers

How is hepatitis B diagnosed?
Hepatitis B diagnosis is by laboratory analyses from a blood sample. The most commonly detected component is the hepatitis B surface antigen (HBsAg). This can be detected within 30 to 60 days after infection, and remains detectable during both acute and chronic infections.

How is hepatitis B treated?
There are no specific treatments for an acute infection. Maintaining an adequate nutritional and fluid intake is important, particularly as additional fluids may be lost through vomiting and diarrhea.

Medications are available for chronic hepatitis B, but only 10% to 40% of individuals with chronic hepatitis B will require treatment. These medications suppress the replication of HBV, thereby slowing the progression of cirrhosis and reducing the risk of liver cancer, but they generally do not cure an HBV infection, so must continue for life (1).

A very effective and safe vaccination for hepatitis B is available. This vaccine induces protective antibody levels in more than 95% of individuals, with protection lasting for at least 20 years and probably lifelong.

References:
1. Hepatitis B, World Health Organization. July 2020.
2. Hepatitis B Questions and Answers for Health Professionals. CDC. July 2020.

Hepatitis

Who is the most at risk for hepatitis C?

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The most common way that hepatitis C is transmitted is through sharing needles. Other potential sources of infection include at birth (~6% of infants of infected mothers), sexual intercourse (rare but more common in men who have sex with men), healthcare exposures, blood transfusions and organ transplants (now very uncommon), unregulated tattoos or body piercings, and sharing personal items that have been contact with infected blood (e.g. glucose monitors, razors) (1).

Those who have an increased risk of hepatitis C include:

  • HIV-positive individuals
  • Current or former injectable drug users
  • Individuals on hemodialysis or who have other selected medical conditions
  • Recipients of blood or organ donations prior to July 1992
  • Recipients of clotting factors before 1987
  • Individuals who received blood from a donor who later tested positive for hepatitis C
  • Health care personnel who may be exposed to blood from infected individuals
  • Children born to hepatitis C-positive mothers

Testing recommendations
The CDC recommends universal hepatitis C screening at least once in a lifetime for all adults and for all pregnant women during each pregnancy, except in populations where the prevalence of hepatitis C is less than 0.1%. Testing should occur in HIV-positive individuals, anyone who has ever injected drugs, individuals with abnormal liver tests and/or liver disease, and in anyone who received donated blood or organs before July 1992 or clotting factor concentrates before 1987. Anyone who has been potentially exposed to the blood of an infected individual should get tested. Regular testing is recommended for individuals who currently use injectable drugs or are on hemodialysis (2).

Cirrhosis associated with hepatitis C
When an individual is infected with hepatitis C their immune system produces specific antibodies against the hepatitis C virus. The presence of these hepatitis C antibodies is consistent with both current and past infections. Up to 50% of individuals who test positive for antibodies to hepatitis C no longer have an active infection (3), which indicates that they have spontaneously cleared the virus after an acute (short-term) infection.

However, more than half of infected individuals develop a chronic (long-term) infection, which can be due to viral changes that evade the immune response (4). Furthermore, 5-25% of all individuals infected with hepatitis C will develop cirrhosis within 10-20 years post-exposure. This is associated with an increased risk of hepatocellular carcinoma and hepatic decompensation.

These factors increase the risk of cirrhosis associated with hepatitis C:

  • Male gender
  • Over 50 years of age
  • Increased alcohol consumption
  • Fatty liver disease
  • Hepatitis B or HIV coinfection
  • Receiving immunosuppressive therapy

References
1. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
2. Testing Recommendations for Hepatitis C Virus Infection. (2020, July). CDC.
3. Seo S, et al. (2020). Prevalence of Spontaneous Clearance of Hepatitis C Virus Infection Doubled From 1998 to 2017. Clin Gastroenterol Hepatol, 18 (2), 511-513.
4. Thomas DL, & Seeff LB. (2005). Natural history of hepatitis C. Clin Liver Dis, 9 (3), 383-398.

Hepatitis

Important things to note if you test positive for hepatitis C

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What does a positive hepatitis C antibody test mean?
A positive result on a hepatitis C antibody test indicates that hepatitis C antibodies were detected in the specimen tested. This result is consistent with a current infection, or a past infection that has resolved, or a biologic false positivity for hepatitis C antibody (1).

What are the next steps?
Consult with a health care professional for follow up testing for hepatitis C nucleic acid (RNA). The detection of hepatitis C RNA utilizes a different lab technique compared to the detection of hepatitis C antibodies.

If hepatitis C RNA is not detected, it indicates a past hepatitis C infection that has resolved, and generally no further action or treatment is required. It is estimated that up to half of all infected individuals are able to spontaneously clear hepatitis C after an acute infection (2).

If hepatitis C RNA is detected, it indicates a current hepatitis C infection. Generally an additional test for hepatitis C RNA is recommended to confirm a current infection before any treatment protocols begin (3).

Management and treatment of an active hepatitis C infection
Appropriate counseling, care and treatment will be organized by the health professional who requested the hepatitis C RNA test (4). Management and treatment options may include:

  • Medical evaluation for chronic liver disease
  • Vaccinations for hepatitis A and hepatitis B (no vaccines are available for hepatitis C)
  • Screening for and control of alcohol consumption
  • HIV testing
  • Direct acting antivirals to limit the replication of the hepatitis C virus and slow the progression of the disease
  • Following a healthy diet and staying physically active
  • Consultations before taking any new prescriptions, medications or supplements (to prevent further potential liver damage)
  • Avoid donating blood, tissue, or semen
  • Covering of cuts and sores to prevent transmission of hepatitis C

References
1. Ghany MG, Strader DB, Thomas DL, & Seeff LB. (2009). Diagnosis, management, and treatment of hepatitis C: An update. Hepatology, 49 (4),1335-1374.
2. Seo S, et al. (2020). Prevalence of Spontaneous Clearance of Hepatitis C Virus Infection Doubled From 1998 to 2017. Clin Gastroenterol Hepatol, 18 (2), 511-513.
3. Hepatitis C. (2020, July). World Health Organization. 
4. Viral Hepatitis – Hepatitis C Questions and Answers for Health Professionals. (2020, August). CDC. 

Hepatitis

What are the differences between hepatitis A, B, and C?

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What is hepatitis?
Hepatitis refers to inflammation and damage to the liver. The most common cause of hepatitis is a viral infection, particularly from the hepatitis A, B, and C viruses, but also including the less common hepatitis D and E viruses (1). Autoimmune hepatitis and excessive alcohol and drug intake are also causes of hepatitis. This article focuses on the similarities and differences between hepatitis A, B, and C, which account for the majority of hepatitis cases.

Functions of the liver
The liver damage associated with hepatitis results in multiple different symptoms, because the liver performs many critical functions, including:

  • Bile production for digestion
  • Filtering of toxins
  • Metabolism of carbohydrates, fats, and proteins
  • Activation of enzymes
  • Storage of various mineral and vitamins
  • Synthesis of blood proteins and clotting factors. 

Hepatitis transmission
Hepatitis A is generally transmitted by the consumption of food or water contaminated with faeces from an infected individual, or through close direct contact with an infectious individual (e.g. oral-anal sex) (2).

Hepatitis B is transmitted through contact with infectious body fluids, including blood, vaginal secretions, and semen. The most common source of transmission is from an infected mother to her child during childbirth. Risk factors for hepatitis B include using injectable drugs, sexual intercourse with an infected partner, and sharing razors (or other products that may have come into contact with blood) from an infected individual (3).

Hepatitis C is usually transmitted through exposure to blood from an infected individual, most commonly through sharing needles. Other potential sources of infection include at birth, sexual intercourse, healthcare exposures, blood transfusions and organ transplants, unregulated tattoos or body piercings, and sharing personal items that have been contact with infected blood (4). 

What are the symptoms of hepatitis?
Many individuals with hepatitis do not show any symptoms or only mild symptoms. Symptoms can include:

  • Fever
  • Loss of appetite
  • Diarrhea
  • Nausea
  • Abdominal pain
  • Dark urine
  • Jaundice

Hepatitis A is an acute (short-term) illness, which does not cause chronic liver disease, and is rarely fatal. However, it can still cause debilitating symptoms resulting in significant economic and social consequences, as it is one of the most frequent causes of foodborne infection. Infected children under six years of age often don’t experience any noticeable symptoms, while older children and adults are more likely to suffer from severe symptoms. The incubation period (time from exposure to onset of symptoms) is usually 14-28 days (2).

Hepatitis B can result in a chronic infection that can develop into cirrhosis or liver cancer. The most at-risk individuals for a chronic infection are infants and young children, with 80-90% of infected infants and 30-50% of infected children under 6 years of age developing a chronic infection. Less than 5% of infected adults will develop a chronic infection, assuming they have no other health complications. The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days (3).  

Hepatitis C can develop into a chronic infection (>50% of infected individuals) (5). Most individuals with chronic hepatitis C also remain asymptomatic or only show general symptoms such as fatigue or depression. Over several decades mild to severe liver disease develops in most affected individuals, including cirrhosis (5-25% of cases) and liver cancer (6). Several factors increase the risk of the development of cirrhosis in infected individuals, including being male, >50 years, increased alcohol consumption, hepatitis B or HIV coinfection, and immunosuppressive therapy (6). Chronic hepatitis C is a common reason for a liver transplant in the United States (7).

Treatment and prevention options for hepatitis
Hepatitis A treatment options aim to maintain comfort and adequate nutrition, particularly the replacement of fluids. Although most infections are mild, the recovery can take several weeks to months in some individuals. The majority of infected people develop immunity to further hepatitis A infection. The transmission of hepatitis A can be reduced by provisions of safe drinking water, proper sewage disposal, and following proper hygiene practices. There are also several effective hepatitis A vaccines available (2).

Hepatitis B treatment focuses on maintaining comfort and adequate nutrition for acute infections. Chronic hepatitis B infections can be treated with various medications, including antivirals, to reduce progression of cirrhosis and incidence of liver cancer. However, these treatments do not generally eliminate the hepatitis C virus, so treatment is life-long. Vaccination is the most effective prevention tool for hepatitis B and is included in routine childhood vaccination schedules worldwide (3).

Hepatitis C affected individuals should be provided with a medical evaluation for liver disease, vaccinations for hepatitis A and B, HIV testing, and advice regarding reduced alcohol consumption and weight management for overweight and obese individuals. Affected individuals should not donate blood, tissue, or semen, and refrain from sharing items that may come into contact with blood (e.g. razors, glucose meters, toothbrushes). Any cuts or sores on the skin should be covered to reduce the risk of transmission. There is currently no available vaccine for hepatitis C. It is treated with antiviral medications to eliminate the virus from the body. Newly developed “direct-acting” antivirals have improved treatment considerably with fewer side effects and shorter treatment periods. Nowadays, over 90% of individuals infected with hepatitis C can be cured with 8-12 weeks of oral therapy (8).

References
1. Hepatitis. from World Health Organization. 
2. Hepatitis A. (2020, July). World Health Organization. 
3. Hepatitis B. (2020, July). World Health Organization. 
4. Viral Hepatitis – Q&As from the Public. (2020, July). CDC. 
5. Liang TJ, Rehermann B, Seef LB, & Hoofnagle JH (2000). Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med, 132 (4), 296-305.
6. Thomas DL, & Seef LB. (2005). Natural history of hepatitis C. Clin Liver Dis, 9 (3), 383-398.
7. Definition & Facts of Liver Transplant. (2017, March). National Institute of Diabetes and Digestive and Kidney Diseases. 
8. Initial Treatment of Adults with HCV Infection. (2020, August). AASLD.