Hepatitis

What is hepatitis?

Hepatitis is a condition that causes inflammation of the liver. Your liver is an organ that helps your body get nutrients from food, cleans your blood and keeps infections away. Some types of hepatitis can stop your liver from functioning properly.

There are five different types of hepatitis caused by viruses: Hepatitis A, B, C, D and E. Hepatitis A, hepatitis B and hepatitis C are most common in the United States. You can get infected with the different types of hepatitis in different ways:

• Contaminated food or water can cause hepatitis A and E. Restaurant workers who have hepatitis A can spread it to others when they handle food.
• Contact with blood or body fluids can cause hepatitis B, C and D.
• Sexual contact or sharing needles can cause hepatitis B and C.

There are also a few other types of hepatitis:

• Alcoholic hepatitis, caused by heavy and/or chronic alcohol use.
• Toxic hepatitis, caused by chemicals, poison, medication or supplements.
• Autoimmune hepatitis, where your immune system attacks your liver.
• Metabolic-associated hepatitis, commonly associated with obesity, diabetes, high cholesterol, hypertension and steatotic/fatty liver.

Symptoms of hepatitis

Hepatitis or liver inflammation usually is asymptomatic (without symptoms), but in some instances patients may experience some of the following symptoms: 

• Fatigue
• Fever
• Jaundice (yellow skin and eyes)
• Stomach or joint pain
• Loss of appetite
• Nausea or vomiting
• Itching
• Dark urine
• Light- or gray-colored stools

Some people with hepatitis may have no symptoms for many years. So, it’s important to know if you are at high risk. Your risk is higher - for viral hepatitis C, in particular - if you:

• Had a blood transfusion or blood products before 1992.
• Were born between 1945 and 1965.
• Have used intravenous (needle) drugs.
• Have snorted cocaine.
• Have received a tattoo with a non-sterile needle (a homemade tattoo or a tattoo acquired in prison).
• Have had sex with multiple unprotected partners.
• Are HIV-positive.
• Were born to a mother who had a hepatitis C infection.

According to the Centers for Disease Control and Prevention (CDC), everyone 18 or older should be screened at least once for hepatitis C.

How is hepatitis diagnosed?

If you have symptoms of hepatitis or you’re at risk for the disease, your doctor or health care provider may recommend different tests. If you do have hepatitis, your provider can figure out what type, how severe it is, and what treatment plan should work best for you.

The process for diagnosing hepatitis isn’t the same for everyone. Your health care provider will recommend tests based on your symptoms, medical history and risk factors.

Diagnosing hepatitis can include:

• Medical history and physical examination: Your provider will ask you about your medical history, including symptoms. They will also check for signs of liver disease, such as jaundice, tenderness or an enlarged liver.
• Blood tests: Blood tests can help diagnose hepatitis. They can uncover which virus you may have and how much, tell your provider if your hepatitis is short-term (acute) or long-term (chronic), check your liver function, and make sure treatments are working.
• Imaging studies: These tests can check on the condition of your liver and look for any abnormalities.
  • Ultrasound, which uses sound waves to create images, can show the size and structure of the liver as well as cysts, tumors or damage.
  • Magnetic resonance imaging (MRI) or computed tomography (CT) scans give more detailed images of the liver so your provider can look closely at the structure of your liver and check for possible issues. 
• Liver biopsy: In some cases, your provider may recommend a liver biopsy. For a biopsy, a needle guided by ultrasound removes a small sample of liver tissue. A health care provider then examines the sample under a microscope to check for liver damage, inflammation and fibrosis (thick or scarred tissue).

How is hepatitis treated?

It’s essential to work closely with your health care provider to come up with a treatment plan that’s best for you. Your provider will recommend one or more of these treatment options based on the type of hepatitis you have (for example viral hepatitis A, B, C, D or E) and whether it is acute or chronic:

Viral hepatitis A

Most people recover from hepatitis A in six months or less without specific treatment. You can manage symptoms by getting plenty of rest, staying hydrated and taking over-the-counter (OTC) pain relievers.

Hepatitis A can be more serious in older people and people with other liver problems. If you develop complications, you might need treatment in a hospital.

Viral hepatitis B

Hepatitis B is common in Africa and Asia, so your provider may want to test you for it if you have lived in those areas. You might not need treatment for acute hepatitis B.

For chronic hepatitis B, you may need long-term treatment. Your doctor may want you to take antiviral medications (entecavir, tenofovir, rarely interferon). These medications can help keep the virus from multiplying and stop your liver from becoming inflamed.

If you take antiviral medications, your doctor will check your liver function and the amount of virus regularly to make sure the treatment is working. 

Viral hepatitis C 

If you have chronic viral hepatitis C, you can take direct-acting antiviral (DAA) medications, which cure hepatitis C 95% of the time. Most people take them for 8 to 12 weeks. Your doctor will want to check your liver function and the amount of virus during and after your treatment.

Viral hepatitis D

This type of hepatitis is unusual since it only happens in people who already have hepatitis B. There aren’t that many treatment options for hepatitis D. Your doctor might recommend antiviral medications that are used for hepatitis B or interferon-alpha injections. If you have hepatitis D, it’s a good idea to see a provider who specializes in treating it. 

Viral hepatitis E

Most people don’t need treatment for hepatitis E. It usually clears up in four to eight weeks. If you have other types of chronic liver disease or a weakened immune system, you might need medical care or treatment in a hospital. 

Alcohol-associated hepatitis

Some patients who drink too much alcohol can develop a form of hepatitis. In this case, the only treatment is to stop drinking alcohol (abstinence) and follow a special diet. If they don’t, they may develop severe symptoms, including bloating (fluid retention), confusion and internal bleeding. These patients may also need to work with an addiction specialist.

Fatty liver (also known as metabolic dysfunction-associated steatotic liver disease)

Some patients are at high risk of getting extra fat in their liver. This may be because of obesity, diabetes, high blood pressure and/or high cholesterol. This extra fat in the liver can lead to inflammation and scarring (cirrhosis, when scarring is severe) and, eventually, liver failure.

Treating the condition that led to the extra fat is the treatment for fatty liver. Exercise and getting to a healthy weight are also very important.

Autoimmune hepatitis

In autoimmune hepatitis, the patient’s immune system mistakenly attacks the liver. If diagnosed with a blood test, usually a liver biopsy is needed. After diagnosis, long term use of medications to hold back the immune system should stop more liver inflammation.   

Depending on the type of hepatitis you have, you may need check-ups, liver function tests or viral load assessments. These steps can check how well treatment is working, spot any complications and see how healthy your liver is overall.

It’s very important to diagnose and treat chronic hepatitis. Chronic infections can lead to complications with how your liver functions – like cirrhosis (scarring), failure and a higher risk of liver cancer. You could need a liver transplant if you have liver failure or liver cancer.

Lifestyle modifications that can help with hepatitis

You can make lifestyle changes to help keep hepatitis under control:

• Avoid alcohol: If you have hepatitis, you shouldn’t drink alcohol. It may make your liver damage worse and also keep antiviral medications from working correctly.
• Choose a healthy diet: You’ll want to eat a balanced diet that is low in fat and includes a variety of fruits, vegetables, whole grains and lean proteins. A dietitian can help you create an eating plan that meets your needs. 
• Vaccinations: Vaccinations for hepatitis A and B can protect you and your loved ones from getting infected. Both shots are part of the CDC’s recommended vaccine schedule for children; however, you can get the vaccines as an adult if you did not get them as a child.
  • If you’ve had hepatitis A or B, you do not need the vaccine for that type as your immune system will now protect you from another infection. 
• Steer clear of things that can damage your liver: Certain medications such as acetaminophen (Tylenol) used in high doses or for long periods of time, as well as vitamin A, illegal drugs and toxic chemicals can cause liver damage. Be sure to talk to your doctor about whether your medications are safe for your liver.

How to prevent viral hepatitis

You can take these steps to reduce your risk of being infected with hepatitis:

• Wash your hands often with soap and water, especially after using the bathroom.
• Get vaccinated for hepatitis A and B. Children up to age 18 should get the hepatitis A and B vaccines if they haven’t already. Everyone up to age 59 should be vaccinated for hepatitis B if they haven’t been.
• During sex, use barrier methods such as condoms and dental dams.
• Avoid sharing needles. Safely dispose any needles and syringes you may use.
• Don’t share razors or toothbrushes.
• Don’t touch someone else’s blood.
• Be cautious while traveling to places that have high levels of hepatitis. You may want to avoid water and ice made from local water, raw fruits and vegetables and raw or undercooked shellfish.

How to connect with support

If you have hepatitis or are concerned about your risk, these resources can provide more information, education and support:

• Centers for Disease Control and Prevention
• World Health Organization
• MedlinePlus 
• American Liver Foundation
• Hepatitis B Foundation
• World Hepatitis Alliance