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Hepatitis

 


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Class
Immune system
Description
Hepatitis is the medical term used to describe inflammation of the liver. Most cases occur as the result of a viral infection, but hepatitis may also be caused by drinking too much alcohol, through damage to the liver caused by medicines or poisoning, or as a result of other diseases such as an obstruction of the bile duct in the liver, disorders of the body's metabolic processes or as a fault in the body's immune system.

The term acute hepatitis is used if symptoms last for less than 6 months, or chronic hepatitis if symptoms last longer than 6 months.

Almost half of all cases of acute hepatitis are caused by a viral infection, and so the remainder of this article will be restricted to an explanation of viral hepatitis.
Causes
There are several types of virus that attack the liver and these are named by letters of the alphabet - hepatitis A, hepatitis B, hepatitis C, hepatitis E and hepatitis G. There is also a hepatitis D, but this only occurs in people infected with hepatitis B. There may also be a hepatitis F, but at the moment there is still scientific debate as to whether this is a distinctive type of hepatitis or not.

Hepatitis A is usually caught through drinking water or eating food such as shellfish that is contaminated with sewage or faeces containing the virus, but occasionally it can be caught from infected blood. After ingestion, the virus is carried to the liver where it multiplies, causing symptoms of acute hepatitis. After multiplying, the virus is excreted in the bile, reaching extremely high concentrations in the faeces, thereby increasing the risk of the virus being passed on to others. Hepatitis A causes an acute form of hepatitis, but does not usually lead to chronic hepatitis.

Hepatitis B and hepatitis C are spread through the transfer of blood or body fluids from a person infected with the virus, for example as may occur during unprotected sex, from sharing contaminated needles, or during blood transfusions. Both types of virus cause acute hepatitis which may eventually develop into chronic hepatitis.

Hepatitis E produces similar symptoms to hepatitis A and is transmitted in a similar way.

Hepatitis A is generally uncommon in the UK because of good standards of sanitation. In 2004, there were just 784 reports of hepatitis A in England and Wales.

Hepatitis B is more common than hepatitis A. It is estimated that there are about 326,000 people in the UK with chronic hepatitis B infection.

There were 8563 confirmed new cases of hepatitis C in England in 2009, a 4.5% increase on 2008.
Symptoms
Symptoms of acute hepatitis include flu-like symptoms such as fever, aches and pains, loss of appetite, tiredness, fatigue, nausea, diarrhoea, tender abdomen and jaundice which causes the skin and whites of the eyes to turn yellow. Jaundice may be accompanied by severe itching. Symptoms vary from person to person; some get no symptoms at all, while others may develop severe liver failure.

In people infected with hepatitis A, symptoms usually appear about 2 weeks after infection, but can develop at any time between 2 to 6 weeks after infection. Although the acute symptoms can be unpleasant, they are very rarely serious and it does not develop into chronic hepatitis. Symptoms and severity of the illness are generally worse the older the person is when they become infected. Almost all people make a complete recovery within 6 months. Less than 1% of patients may develop a sudden and severe course of illness, characterised by worsening jaundice and encephalopathy, requiring prompt referral to a specialist liver unit.

Approximately 5-10% of people with hepatitis B and 80% of those with hepatitis C may go on to develop chronic hepatitis. The majority of these may not show any symptoms for years. Liver damage typically occurs slowly over 20-30 years and can lead to jaundice, liver fibrosis, cirrhosis and ultimately to liver cancer or liver failure and death. People sometimes only become aware of chronic hepatitis when they develop liver cancer or advanced cirrhosis by which time it can be too late.
Prevention and treatment
Hepatitis A
The best form of protection against hepatitis A is immunisation using a vaccine specifically against the virus. People who are at occupational risk, for example sewage workers, or people who are travelling to countries where there is poor sanitation and the hepatitis A virus is common, for example in the Indian Sub-Continent, Africa and the Far East, should receive a course of two injections that will provide protection against hepatitis A for life. The vaccine can also be used to provide protection for people who have been recently (less than 2 weeks) exposed to hepatitis A.

If someone does become infected with hepatitis A, there is no specific antiviral treatment available. Treatment is generally supportive, including appropriate rest and a healthy, balanced diet. Alcohol and paracetamol consumption should be avoided to reduce further damage to the liver. Most people infected with the virus make a complete recovery from the acute symptoms within a few months, and symptoms do not return again as the body has built up an immunity to the virus.

Hepatitis B and C
The best form of protection against hepatitis B is immunisation using a course of injections with a vaccine specifically against the virus. The vaccine is particularly recommended for people who are likely to come into close contact with blood or body fluids infected with hepatitis B such as nurses, paramedics and others in the health professions, those whose partner is infected with hepatitis B, and intravenous drug users. There is no vaccine against hepatitis C.

If someone does become infected and the disease progresses to chronic hepatitis B or chronic hepatitis C, they will require treatment with antiviral drugs. For the treatment of chronic hepatitis B, antiviral drugs such as interferons and pegylated interferons, adefovir, entecavir, lamivudine and telbivudine may be prescribed.

Interferons and pegylated interferons are also used for the treatment of chronic hepatitis C, but are used in combination with another antiviral drug called ribavirin to increase their effect.
When to see your pharmacist
Although your local pharmacy may be able to supply simple analgesics for the relief of the flu-like symptoms that accompany acute hepatitis, it is advisable to visit your doctor so that your condition can be closely monitored.

Your pharmacist will however be able to give advice about the vaccinations that you will need if travelling abroad, and will be able to offer advice on some precautions to take to avoid becoming infected.
When to see your doctor
If you have been in contact with someone who has hepatitis A, hepatitis B or hepatitis C or you think that you may have been at risk of being infected, go to see your doctor. If you prefer to be anonymous, then visit your local Genito-Urinary Medicine (GUM) or Sexual Health clinic, or your local Drug Dependency Unit. A blood sample will be taken to test for antibodies to the viruses to confirm whether you have hepatitis A, B or C. Your blood may also be tested for the presence of certain enzymes to assess whether your liver has been damaged.
Living with hepatitis
Reducing the risk of getting hepatitis
The chances of being infected with hepatitis A can be reduced considerably by observing strict rules of hygiene. Always thoroughly wash your hands after going to the toilet. If in countries where there is a high risk of hepatitis A and the standard of hygiene is poor, do not drink the local water or use ice cubes made from the local water. Peel fruit and avoid all salads unless they can be washed in water that you know is clean.

To reduce the risk of being infected with hepatitis B and hepatitis C avoid contact with blood and body fluids. Use a condom if having sex. Never share needles if you are an intravenous drug user. If you are having a tattoo, need to visit a dentist or require medical assistance always go to a reputable practice that maintains high standards and uses new equipment and sterilises its instruments.

If you are travelling abroad to areas of poor hygiene, or if your occupation exposes you to a risk of being infected with any of the hepatitis viruses, then visit your doctor to discuss the need for immunisation.

Reducing the risk of spreading hepatitis
If you have hepatitis A, then you should take all necessary steps to avoid passing the disease on to others. Strict rules of toilet hygiene should be used during the infectious period particularly if there is diarrhoea or faecal incontinence. If your work involves food preparation, you should inform your employer and stay off work until your doctor advises that it is safe for you to return; usually 1 week after onset of jaundice. Scrupulous standards of hygiene during food preparation should be maintained.

If you have hepatitis B or C, you should inform your sexual partners and other people with whom you live and advise them to be tested for immunity against hepatitis B and to be vaccinated if they are not immune. Condoms should be used during sex if your partner is not vaccinated or is not immune. Razors, toothbrushes, needles and syringes should not be shared; cuts should be covered and any spillage of blood should be cleaned with bleach. Items such as sanitary towels, tampons, bandages and plasters should be disposed in plastic bags. Donation of blood, organs or sperm is prohibited.

Keeping healthy
If you have acute hepatitis avoid alcohol during your recovery and limit your alcohol consumption once fully recovered. If you have chronic hepatitis, give up alcohol completely to avoid further damage to the liver.

If you need to take pain killers, it is best to avoid paracetamol and to take products such as ibuprofen that are less damaging to the liver. If buying any over the counter medicines or healthcare supplements, always tell the pharmacist that you have hepatitis and say which medicines you are taking as some preparations, for example vitamin supplements containing large doses of vitamin A or vitamin D, can damage the liver.

If you are on any treatments for hepatitis B or hepatitis C, it is important that you take the medicines as prescribed. Attend for regular liver function tests to determine whether your disease is progressing and whether there are any signs of cirrhosis or liver cancer.

Maintain a good relationship with your doctor or liver specialist. Talk to them about any concerns that you may have about your disease or treatment, or the way that you feel. Tell you doctor if you should become pregnant, or if you are thinking of starting a family discuss the options with your doctor first. Try to remain positive, many people with chronic hepatitis live for years without becoming seriously ill or developing liver failure.
Further information
Based on information supplied by The Hepatitis C Trust The Hepatitis C trust is the only national UK hepatitis C charity. All of its staff, both paid and voluntary, either have hepatitis C or have had it cleared after treatment. It runs a range of services that provide support, information and representation for people with hepatitis C. It is committed to raising awareness and lowering the stigma of this disease amongst the general population.

Helpline: 0845 223 4424 (10.30 to 16.30 Monday to Friday)
Helpline@hepctrust.org.uk

The Hepatitis C Trust
27 Crosby Row
London SE1 3YD
Office: 020 7089 6220
Fax : 020 7089 6201
Email : admin@hepctrust.org.uk
http://www.hepctrust.org.uk


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