Understanding Hepatitis -- Diagnosis and Treatment

How Do I Know If I Have Hepatitis?

Viral hepatitis, such as hepatitis C (HCV), hepatitis B (HBV) and hepatitis A (HAV), is diagnosed by your symptoms, a physical exam, blood tests, and other studies, such as FibroSure. Sometimes imaging studies such as a sonogram or CAT scan and a liver biopsy are also used.

Hepatitis: Who's at Risk?

For hepatitis C, the CDC recommends that you have a blood test if any of the following is true:

  • You have received an organ transplant or transfusion in the past.
  • You have been notified that you received blood or an organ transplant from a donor who later tested positive for the disease
  • You have ever injected drugs, even once many years ago
  • You received a blood transfusion or an organ transplant before July 1992
  • You received a blood product used to treat clotting problems that was made before 1987
  • You were born between 1945 and 1965
  • You have had long-term kidney dialysis
  • You have signs or symptoms of liver disease
  • You have HIV
  • You have a known exposure to HCV
  • You have persistent elevations of a liver blood test called ALT (alanine aminotransferase levels)

Other people for whom hepatitis C virus testing is indicated include:

  • Children born to HCV-positive mothers
  • Hospital and other health care facility workers after a needle stick or exposure to the blood of a person with HCV
  • Public safety and emergency medical workers after a needle stick or exposure to the blood of a person with HCV

The following people who are at increased risk for contracting hepatitis B virus include:

  • People who received a blood or a blood-product transfusion prior to 1972
  • Hospital and health care workers
  • Household members of an infected person
  • Intravenous drugs users (both present and former users)
  • People who have had a tattoo or a body part pierced with an infected needle
  • Sex partners of infected people
  • Travelers to countries where HBV is endemic
  • People who were born to a mother infected with HBV
  • Transplant-organ recipients who received an infected organ

The following groups of people should be screened for hepatitis B virus:

  • People born in areas where HBV is endemic
  • Men who have sex with men
  • Intravenous drug users (both present and former users)
  • Dialysis patients
  • HIV-infected people
  • Pregnant women
  • Family members, household members, and sex partners of HBV-infected people (even if sex occurred on only one occasion)
  • People who have had more than one sex partner within 6 months

Otherwise, routine screening for hepatitis typically is not recommended unless you have symptoms or signs (such as abnormal liver-related blood tests) of the condition.

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What If I Have Symptoms of Viral Hepatitis?

If you have symptoms or signs of viral hepatitis, your health care provider can perform a blood test to check for the presence of an antibody. If you have hepatitis, more blood samples may be necessary later -- even if the symptoms have vanished -- to check for complications and determine if you have progressed from acute (infected within the past six months) to chronic (having the virus for greater than six months) disease. Most people have vague or no symptoms at all; hence, viral hepatitis is often referred to as a silent disease.

Your health care provider may also require a liver biopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is then sent to a lab to be analyzed.

 

What Are the Treatments for Viral Hepatitis?

The treatment for viral hepatitis depends on the type and stage of the infection. Over the last several years, excellent treatments for both hepatitis B and C have become available. More and improved treatments are being evaluated all the time.

Your primary care doctor should be able to provide adequate care of your hepatitis. However, if you have severe hepatitis, you may require treatment by a hepatologist or gastroenterologist -- specialists in diseases of the liver. Hospitalization is normally unnecessary unless you cannot eat or drink or are vomiting.

Doctors sometimes recommend drug therapy for people with certain types of hepatitis. Antiviral medication for hepatitis B includes adefovir dipivoxil (Hepsera), entecavir (Baraclude), interferon, lamivudine (Epivir), peginterferon, telbivudine (Tyzeka), and tenofovir (Viread).

Until recently, the standard treatment for chronic hepatitis C was a course of peginterferon plus ribavirin for people with genotype 2 and 3, and peginterferon plus ribavirin plus a protease inhibitor - either boceprevir (Victrelis) or telaprevir (Incivek) for people with genotype 1. These treatments had been shown to be effective in from 50% to 80% of those infected with hepatitis C.

More recently, two new direct acting antiviral drugs, simeprevir (Olysio) and sofosbuvir (Sovaldi) were approved by the FDA to treat chronic HCV infection. When used as part of a treatment plan, they can be effective in 80%-95% of patients. Sofosbuvir (Sovaldi) blocks a protein needed by the hepatitis C virus to multiply. It is approved for use with pegylated interferon and ribavirin for HCV genotype 1 and 4 infections, and with ribavirin for adults with HCV genotype 2 and 3 infection. This is the first time an interferon-free regimen has been approved to treat chronic hepatitis C. Imeprevir (Olysio) also blocks a protein needed by the hepatitis C virus to multiply. It is approved for use with peginterferon-alfa and ribavirin for genotype 1 infections only.

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In addition, the newer drugs daclatasvir (Daklinza), ombitasvir, paritaprevir and ritonavir (Technivie), ombitasvir-paritaprevir-dasabuvir-ritonavir (Viekira Pak), and  sofosbuvir-ledipasvir (Harvoni), are approved to treat chronic HCV genotype 1.

Also, many drugs have at one time or another been implicated as a cause of liver damage. If you currently have hepatitis, or if you have a history of liver disease or other liver problems, tell your health care provider before taking any medication - either prescription or over-the-counter, including herbal therapies.

Hepatitis in Pregnant Women

Hepatitis in pregnant women usually does not increase the risk of birth defects or other pregnancy problems, and infection of the unborn baby is rare. However, hepatitis E can be fatal to a pregnant woman during her third trimester, and if the mother has hepatitis B, the baby is likely to contract the disease at birth.

If you are pregnant, your doctor will test you for hepatitis B; if you are infected with the virus, your baby will be given immune globulin shots and a hepatitis vaccination. This will help protect your baby from contracting the virus. In addition, it may be recommended that a mother with active HBV receive treatment with an antiviral medication during the third trimester of pregnancy.

Other Points to Consider

If your hepatitis, either viral or nonviral, is in the acute stage (occurred within the last six months), avoid alcoholic beverages, as your body's efforts to process alcohol puts an added strain on an already injured liver. Also, be aware that your sexual partners, especially if you have hepatitis B, may run the risk of contracting the disease. Hepatitis C is difficult to pass through sexual contact, unless there is blood-to-blood contact.

Most adults recover completely from acute hepatitis A and B within six months. Mild flare-ups may occur over a period of several months as the disease is subsiding, but each flare-up is usually less severe than the one before it, and a relapse doesn't mean you won't make a full recovery.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on December 10, 2015

Sources

SOURCES:

American Academy of Family Physicians.

WebMD Medical Reference: "Hepatitis C."

WebMD Medical Reference: "Hepatitis B."

WebMD Medical Reference: "Combination antiviral therapy for hepatitis C."

Manual of Family Practice.

FDA.

 

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