Hepatitis

Hepatitis and the liver#

Hepatitis means inflammation of the liver. The liver carries out many important jobs in the body, including regulating metabolism, making proteins, and storing vitamins and iron. If the liver does not work properly, it can cause serious illness and sometimes even death.

Hepatitis can be caused by infection, viruses, chemicals, alcohol and other drug use, among other factors. Chronic hepatitis means ongoing inflammation of the liver, whatever the underlying cause.

Types of viral hepatitis#

The various forms of viral hepatitis are named after letters of the alphabet: hepatitis A, B, C, D and E. They are sometimes shortened to hep A, hep B, hep C, and so on. While all these viruses affect the liver, they are spread in different ways and have different treatments. The most common types of viral hepatitis in many countries are hepatitis A, B and C.

Symptoms of hepatitis#

It is very important to know that not everyone with hepatitis has symptoms. Many people feel healthy even though their liver is being damaged. The only way to know for certain whether you have hepatitis is to talk to your doctor and have a blood test.

When symptoms do occur, they may include:

• Jaundice (yellowing of the skin and eyes)
• Fever
• Nausea
• Abdominal discomfort
• Dark urine
• Lethargy (tiredness)
• Painful joints
• Oedema (swelling)
• Easy bruising

Hepatitis A#

Anyone can be at risk of hepatitis A. It is passed on through direct contact with the virus, usually through food, drinks or objects contaminated by the faeces of an infected person. Symptoms may last several weeks, but people usually recover completely.

Infection with hepatitis A gives lifelong immunity. However, this does not protect against the other types of hepatitis. A vaccine is available to protect against hepatitis A.

Hepatitis B#

Hepatitis B is spread when blood, semen, vaginal secretions or other body fluids from someone with the virus enter the bloodstream of someone who does not have it. This can happen through unsafe sex or the use of shared injecting equipment. Hepatitis B can also be passed from mother to child at or shortly after birth, and on rare occasions through the womb.

People exposed to the virus may develop chronic hepatitis B, where the virus stays in their body for life. Babies and children who become infected are far more likely than adults to develop chronic infection.

Screening the mother before birth can prevent infection of newborn babies. If a mother tests positive, the baby is given hepatitis B immunoglobulin at birth, along with a hepatitis B vaccination. A highly effective and safe vaccine is available to prevent hepatitis B, and it is included in standard immunisation schedules.

Hepatitis C#

Hepatitis C is a bloodborne virus that spreads when blood from an infected person enters another person’s bloodstream. The most common way it is passed on is through sharing injecting drug equipment.

Around 30% of people who become infected clear the virus from their blood within a few months without any treatment. These people no longer have hepatitis C and cannot pass it on. The remaining 70%, if untreated, continue to carry the virus and are likely to develop chronic hepatitis C. Of these, about 10 to 20% will develop cirrhosis, which is serious scarring of the liver. This can take 20 years or more to develop, and cirrhosis increases the risk of liver cancer.

Treatment with direct-acting antiviral medicines has greatly improved outcomes. These medicines reduce inflammation in the liver and can clear the virus in up to 95% of people, with minimal side effects. There is no vaccine to prevent hepatitis C, and it is possible to be infected again even after a previous infection has cleared.

Hepatitis D#

Hepatitis D is uncommon in many regions but is more common in areas with a high rate of hepatitis B. It can be acquired either as a co-infection at the same time as hepatitis B, or as a super-infection in people who are already hepatitis B positive. You can get hepatitis D through unsafe sex, sharing injecting equipment, and other activities where the blood of an infected person enters your bloodstream.

Hepatitis E#

Hepatitis E is most common in low-income countries and regions. There is no long-term (chronic) infection associated with this virus. It tends to be more severe in pregnant women, especially in the third trimester.

The virus is found in the faeces of infected people and animals, and is spread by eating or drinking contaminated food or water. Person-to-person spread is less common than with hepatitis A. Pregnant women are strongly advised not to travel to areas where hepatitis E is common, especially during the last three months of pregnancy.

Diagnosis of hepatitis#

Tests used to diagnose hepatitis may include:

• Blood tests
• Liver ultrasound
• A fibroscan, a quick, non-invasive test that uses ultrasound to measure the stiffness of your liver

Treatment for hepatitis#

Treatment depends on the type of hepatitis, so talk to your doctor about what is recommended for you. Chronic viral hepatitis, whether due to hepatitis B or C, can, after many years, lead to cirrhosis and primary cancer of the liver.

Key points#

• If the liver does not work properly, it can cause serious illness or sometimes even death.
• Chronic hepatitis means ongoing inflammation of the liver, whatever the underlying cause.
• All these viruses affect the liver, but they are spread in different ways and have different treatments.
• The most common types of viral hepatitis in many countries are hepatitis A, B and C.
• It is very important to know that not everyone with hepatitis has symptoms.

Where to get help#