Understanding Hepatitis -- Diagnosis and Treatment

How Do I Know If I Have Hepatitis?

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

What are the types of Hepatitis ?

There are several types of hepatitis, but the three most common in the U.S. are:

  • Hepatitis A – It is considered highly contagious but is not a long-term infection and usually has no complications. Your liver usually heals within two months. Preventable with a vaccination, it can be spread by eating or drinking something that has been contaminated with the stool of a person who has the virus.
  • Hepatitis B – While it can lead to long-term liver damage, most children and adults recover within 6 months. You can spread the virus even though you show no symptoms. A pregnant woman who is infected by the virus can pass it along to her newborn.  Also, preventable through vaccine, hepatitis B is spread by:
    • Having sex with someone who's infected
    • Sharing dirty needles
    • Having direct contact with infected blood or the body fluids of someone who's got the disease
  • Hepatitis C – Usually a long-term infection, those infected often don’t show symptoms. It can lead to scarring of the liver or cirrhosis. There is no vaccine to prevent it. It is spread by:
    • Sharing dirty needles
    • Having direct contact with infected blood or the body fluids of someone who's got the disease
    • Have had a blood transfusion prior to screenings put in place in 1992
    • It is possible but less common to contact it through sex with someone who is infected

Who's at Risk for Hepatitis Infection?

You are at increases risk hepatis A if you meet one or more of these criteria:

  • You knowingly have had direct contact with persons who have hepatitis A
  • Have traveled to a country that is known to have a high incidence of HAV infection
  • Have been in close contact with someone who has traveled to a country with a high rate of infection
  • Are a male in a sexual relation with another male
  • Use drugs
  • Have a clotting factor disorder
  • You work with primates

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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)
  • Anyone with chronic kidney disease
  • 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
  • People who will need to be on medicines that will weaken their immune system.
  • People with hepatitis C
  • Children born to mothers who have HBV
  • People with certain high liver function blood tests

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 before July 1972.
  • 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)
  • Children born to HCV-positive mothers

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.

What are the Symptoms of Viral Hepatitis?

Many people with hepatitis will not have any symptoms at all. When they do occur, symptoms of all three of the most common types of hepatitis are very similar and may include:

  • Dark urine
  • Stomach pain
  • Yellowing of skin or eyes
  • Pale or clay-colored stool
  • Low-grade fever
  • Loss of appetite
  • Fatigue
  • Feeling sick to the stomach

If you have hepatitis A or B, you may also have achy joints.

See your doctor as soon as possible if you have any of these symptoms.

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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 B or C, 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 healthcare 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.

Hepatitis A usually requires minimal treatment and your liver usually heals within 2 months. Make sure you stay hydrated and well-nourished. While a vaccination can prevent you from getting hepatitis A, once you have had it, you cannot be re-infected.

Doctors sometimes recommend drug therapy for people with hepatitis B and C. Antiviral medication for hepatitis B includes adefovir (Hepsera), entecavir (Baraclude), interferon, lamivudine (Epivir), peginterferon, telbivudine, 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 for people with genotype 1. These treatments had been shown to be effective in from 50% to 80% of those infected with hepatitis C but the side effects were very difficult for people to tolerate.

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Treatment now centers around direct acting antiviral drugs (DAAs). These medicines are highly effective for most people with hepatitis C and are interferon-free and often ribavirin-free. This means they typically have fewer side effects. The treatments are often simpler- consisting of fewer pills for a shorter amount of time. DAAs are available as either single drugs or combined with other medicines in one pill. Elbasvir-grazoprevir (Zepatier), ledipasvir-sofosbuvir ( Harvoni), and sofosbuvir-velpatasvir (Epclusa) and are once daily combination pills. Depending on the type of hepatitis C infection, these can often cure the disease in 8 to 12 weeks. Other treatment options include: ombitasvir-paritaprevir-rritonavir plus dasabuvir  (Viekira Pak, Viekira XR); ombitasvir-paritaprevir-ritonavir (Technivie), or some combinations of daclatasvir (Daklinza), peginterferon, ribavirin, or sofosbuvir (Sovaldi).  Ask your doctor what's best for you, based on your medical needs.

Hepatitis in Pregnant Women

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.

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.

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, are at 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. 

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on June 14, 2019

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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