Hepatitis Survivors

What Is hepatitis?

Hepatitis refers to an inflammatory condition of the liver.

• It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol.
  • Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.
• Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including:
  • bile production, which is essential to digestion
  • filtering of toxins from your body
  • excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
  • breakdown of carbohydrates, fats, and proteins
  • activation of enzymes, which are specialized proteins essential to body functions
  • storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
  • synthesis of blood proteins, such as albumin
  • synthesis of clotting factors
• According to the Centers for Disease Control and Prevention (CDC), approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis.

The 5 types of viral hepatitis

• Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.
• Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

Hepatitis A

• is caused by an infection with the hepatitis A virus (HAV).
• This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.
• Certain sex practices can also spread HAV.
• Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening.
• Most people in areas of the world with poor sanitation have been infected with this virus.

Hepatitis B

• is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV).
• Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
• HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood.
• Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.
• HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients.
• It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C

• comes from the hepatitis C virus (HCV).
• Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact.
• HCV is among the most common bloodborne viral infections in the United States.
• Approximately 2.7 to 3.9 million are currently living with a chronic form of this infection.

Hepatitis D

• Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV).
• HDV is contracted through direct contact with infected blood.
• Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection.
• Hepatitis D can only infect people already infected with hepatitis B.
• The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E

• is a waterborne disease caused by the hepatitis E virus (HEV).
• Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply.
• This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC.

Causes of noninfectious hepatitis

• Alcohol and other toxins
  • Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis.
  • The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver.
  • Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.
• Autoimmune system response
  • In some cases, the immune system mistakes the liver as a harmful object and begins to attack it.
  • It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.

Common symptoms of hepatitis

• If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms in the beginning.
• Symptoms may not occur until the damage affects liver function.
• Signs and symptoms of acute hepatitis appear quickly. They include:
  • fatigue
  • flu-like symptoms
  • dark urine
  • pale stool
  • abdominal pain
  • loss of appetite
  • unexplained weight loss
  • yellow skin and eyes, which may be signs of jaundice
• Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

How hepatitis is diagnosed

• History & physical exam
• Liver function blood tests
• Other blood tests
• Ultrasound
• Liver biopsy

How hepatitis is treated

Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.

Hepatitis A

• Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort.
• If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.
• The hepatitis A vaccine is available to prevent this infection.
  • Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines.
  • Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.

Hepatitis B

• Acute hepatitis B doesn’t require specific treatment.
• Chronic hepatitis B is treated with antiviral medications.
• This form of treatment can be costly because it must be continued for several months or years.
• Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.
• Hepatitis B can be prevented with vaccination.
  • The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood.
  • The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis C

• Antiviral medications are used to treat both acute and chronic forms of hepatitis C.
• People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.
• People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.
• Currently, there is no vaccination for hepatitis C.

Hepatitis D

• No antiviral medications exist for the treatment of hepatitis D at this time.
• According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people.
• Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop.

Hepatitis E

• Currently, no specific medical therapies are available to treat hepatitis E.
• Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol.
• Pregnant women who develop this infection require close monitoring and care.

Autoimmune hepatitis

• Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.
• Azothioprine (Imuran), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids.
• Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.

Statistics & Prognosis

• Worldwide in 2015, hepatitis A occurred in about 114 million people, chronic hepatitis B affected about 343 million people and chronic hepatitis C about 142 million people.
• In the United States, NASH affects about 11 million people and alcoholic hepatitis affects about 5 million people.
• Hepatitis results in more than a million deaths a year, most of which occur indirectly from liver scarring or liver cancer.
• In the United States, hepatitis A is estimated to occur in about 2,500 people a year and results in about 75 deaths.
• Nearly all patients with hepatitis A infections recover completely without complications if they were healthy prior to the infection. Similarly, acute hepatitis B infections have a favorable course towards complete recovery in 95–99% of patients.
• In contrast to hepatitis A & B, hepatitis C carries a much higher risk of progressing to chronic hepatitis, approaching 85–90%. Cirrhosis has been reported to develop in 20–50% of patients with chronic hepatitis C.
• Acute hepatitis B infections become less likely to progress to chronic forms as the age of the patient increases, with rates of progression approaching 90% in vertically transmitted cases of infants compared to 1% risk in young adults. Overall, the 5-year survival rate for chronic hepatitis B ranges from 97% in mild cases to 55% in severe cases with cirrhosis.
• Overall, the 5-year survival rate for chronic hepatitis B ranges from 97% in mild cases to 55% in severe cases with cirrhosis.

Resources & Additional reading:

• Healthline – Hepatitis
• On Health – A quick guide to hepatitis. Reviewed by: Charles Patrick Davis, MD, PhD on 1/31/2020
• WHO – What is hepatitis?
• Wikipedia – Hepatitis
• Mayo Clinic – Hepatitis A – Overview
• MedicineNet – Hepatitis (Viral Hepatitis A, B, C, D, E, G)
• Medical News Today – What’s to know about viral hepatitis?
• WHO – “My untold story” – A hepatitis patient in Ghana shares his experience
• Living with Hepatitis B, A Survivor’s Guide. From: Viral Hepatitis Program, Alaska Native Medical Center, Anchorage, Alaska – Gastroenterology - Nov 2002, Vol 123, issue 5, pages 1745-1746) By: Mary Snowball, RN; Brian J McMahon, MD
• Hepatitis Central – Hepatitis C Survivor Stories