HEPATITIS

Hepatitis is an inflammation of the liver due to

toxins, such as chemicals or drugs or infectious
agents. Hepatitis that lasts less than 6 months is
called "acute hepatitis," hepatitis that lasts more than
6 months is called "chronic hepatitis".
Hepatitis usually occurs because of a virus,
especially one of the five hepatitis viruses, A, B, C, D
or E. Hepatitis can also occur due to other viral
infections, such as infectious mononucleosis, yellow
fever and cytomegalovirus infection. Causes of nonviral hepatitis is the main alcohol and drugs.

Type of Hepatitis
Hepatitis A
Hepatitis A is the most common of the seven known types of viral hepatitis.
Infection with the hepatitis A virus leads to inflammation of the liver, but
complications are rarely serious.
How hepatitis A is spread
The hepatitis A virus (HAV) is found in the faeces of someone infected with the
virus. It only takes a tiny amount of faeces getting inside another persons
mouth to cause hepatitis A infection. Personal hygiene, such as careful hand
washing, can minimise the risk of the virus being passed on.
HAV is a common infection in many parts of the world where sanitation and
sewage infrastructure is poor. Often people become infected with HAV by eating
or drinking contaminated food or water.
Hepatitis A is also classed as a sexually transmitted disease (STD) because it can
be passed on sexually, particularly during activities such as anilingus (rimming).
The washing of genital and anal areas before sex, and the use of condoms or
dental dams can help to prevent this risk.
Hepatitis A can affect all age groups. Once a person is exposed to the virus it
takes between 2 and 6 weeks to produce symptoms.

Treatment for hepatitis A

There is no specific treatment for HAV and most people fight off the virus
naturally, returning to full health within a couple of months. The doctor will
advise avoiding alcohol and fatty foods as these can be hard for the liver to
process and may exacerbate the inflammation.
Patients should get plenty of rest and eat a nutritious diet. They should also
ensure they do not spread HAV by washing their hands after using the toilet
and before preparing food. Patients with more severe symptoms may be
monitored in hospital for a short period.
Hepatitis A immunisation
Hepatitis A immunisation is given in a series of injections. The first single
injection in the arm gives protection for a year. The second booster injection at
6 to 12 months extends protection for up to 10 years.
The hepatitis A vaccine may be routinely recommended for young children
living in areas with high incidence of hepatitis A, and anyone travelling to
countries where hepatitis A is endemic. In addition, immunisation may be
recommended for people whose sexual practices are likely to put them at risk.
Immunisation may also be recommended to prevent hepatitis A developing if a
person suspects they have been exposed to the virus.

B. Hepatitis B
Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic longterm illness and permanent damage to the liver if not treated.
How hepatitis B is spread
The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people
infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.
Hepatitis B is most frequently passed on through the exchange of bodily fluids with an
infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.1
HBV can be spread in the following ways:
By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina
or mouth) with someone who is infectious. Also by sex that draws blood with someone who is
infected.
By sharing contaminated needles or other drug-injecting equipment.
By using non-sterilised equipment for tattooing, acupuncture or body piercing.
From an infected mother to her baby, most commonly during delivery. Immunisation of the
baby at birth prevents the transmission of hepatitis B.
Through a blood transfusion in a country where blood is not screened for blood-borne viruses
such as HBV.
Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with
the faeces of someone who is infected.

Signs and symptoms of hepatitis B

Many people who become infected with HBV experience mild symptoms or no
symptoms at all, but they may still carry the infectious virus and pass it on to others.
When symptoms do appear they are similar to those of hepatitis A and may include:
A short, mild, flu-like illness;
nausea, vomiting and diarrhoea;
loss of appetite;
weight loss;
jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
itchy skin.
If symptoms become severe then a person with hepatitis B may be admitted to
hospital.
Most adults infected with the hepatitis B virus fully recover and develop life-long
immunity. Between 2% and 10% of individuals infected as adults will become chronic
carriers, which means they will be infectious to others and can develop chronic liver
damage. Infected children, especially newborn babies, are much more likely to
become chronic carriers.
If a person lives with hepatitis B infection for a number of years then they may
develop the following complications:
chronic hepatitis
liver cirrhosis
liver cancer

Where to go for help

If you have any symptoms or you are worried you may have been
infected with hepatitis B, you should discuss your worries with a doctor.
They may be able to run tests themselves, or else will refer you to
someone who can.
Some countries have specific sexual health clinics that can help you
directly.
What does a positive test result mean?
A positive test result could indicate either of the following:
A past infection. This means the patient has already been in contact
with hepatitis B and their immune system has succeeded in fighting
off the virus. The patient will then have a natural immunity to the virus.
The patient is a carrier. This means the patient is carrying HBV and
can pass it on to others. The person may not display any symptoms but
could be at risk of developing chronic liver disease.
A doctor may perform a number of different types of test to distinguish
between current and past infections, and to estimate how infectious a
patient with a current infection may be.

What does a negative test result mean?

This result generally means the patient has never been infected with HBV and therefore
has no natural immunity against the virus. If the person suspects they may have been
recently exposed to HBV, the doctor may advise them to take a repeat test to confirm
their negative status, and may also advise immunisation against hepatitis B.
Treatment for hepatitis B
In most countries a patient with a positive test result will be referred to a specialist who
will carry out further tests to determine the degree to which hepatitis B may be affecting
the liver, and what may be the best treatment options. In these tests a small sample of
liver tissue may need to be taken (a liver biopsy).
In the majority of patients with active HBV, symptoms will not be severe and treatment
will not be required. The patient will be monitored and after a few months the patients
immune system should fight off the virus, giving the patient natural immunity.
In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV
infection will become chronic. The virus is more deadly to the young and those that are
infected at birth have a 25% chance of developing a life-threatening liver-related illness.
Antiviral medication is given as treatment to those with chronic symptoms to help
prevent further liver damage. These medications may be injected or given in pill form.
Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6
months, during which time the patient will be carefully monitored.
Regardless of whether the infection is producing symptoms or not, the patient will be
advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

Hepatitis B immunisation
Three immunisation injections are given over
a period of 3-6 months. A blood test is taken
once the course of injections is completed to
check they have worked. Immunity should last
for at least 5 years.

Hepatitis C
Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C
virus is transferred primarily through blood, and is more persistent than hepatitis A or B.2
How hepatitis C is spread
The hepatitis C virus (HCV) can be spread in the following ways:
By sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary
transmission route for HCV outside sub-Saharan Africa.
By using non-sterilised equipment for tattooing, acupuncture or body piercing. This
can be a problem in countries where tattooing or scarification is a traditional ritual
practice.
Through exposure to blood during unprotected sex with an infected person. Blood may
be present because of genital sores, cuts or menstruation. Sexual transmission is an
uncommon way of becoming infected with hepatitis C.
Rarely, from an infected mother to her baby during childbirth. The risk may be greater
if the mother is also infected with HIV.
Through blood transfusion. In many developing countries blood is not screened (tested)
for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
By sharing equipment used to snort cocaine. Usually this is a rolled banknote, which
can become contaminated with blood from a persons nose.
Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water,
sharing cutlery, or casual contact.

Signs and symptoms of hepatitis C

Many people do not have symptoms when they become infected with hepatitis C. Symptoms may
emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not
develop any symptoms and their immune system will successfully clear the virus without their
knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to
others.
Symptoms may include:
A short, mild, flu-like illness;
nausea and vomiting;
diarrhoea;
loss of appetite;
weight loss;
jaundice (yellow skin and whites of eyes, darker yellow urine and pale

faeces);

itchy skin.
About 20% of individuals who become infected with HCV will clear the virus from their body within
6 months, though this does not mean they are immune from future infection with HCV.
The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause
mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest
of their lives and will remain infectious to others.
If a person lives with hepatitis C infection for a number of years then they may develop the following
complications:
chronic hepatitis
liver cirrhosis
liver cancer
If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring
and treatment.

Where to go for help

If you have any symptoms or you are worried you may
have been infected with hepatitis C, you should discuss
your worries with a doctor. They may be able to run tests
themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that
can help you directly.
The tests for hepatitis C
Tests for the hepatitis C virus have only been available
since 1989. A doctor can diagnose hepatitis C by carrying
out blood tests that detect HCV antibodies in the blood.

What does a positive test result mean?

The first test searches for HCV antibodies in the patients blood.
A positive result shows that the person has been exposed to the
hepatitis C virus and their immune system has responded by
producing antibodies.
This may mean that the patient is a carrier of the hepatitis C
virus. Alternatively, the patient may have recently cleared an HCV
infection and still have antibodies in their blood. Further tests will
be conducted to find out whether the patient has a current
infection.
A specialist will carry out a blood test that looks for the genetic
material of the hepatitis C virus itself instead of the antibodies.
This test will identify whether the virus is still present.
If the patient has successfully cleared the virus, this does not
mean they are immune to reinfection.

What does a negative test result mean?

A negative result generally means the patient
has never been infected with HCV. However,
as the tests rely on the detection of antibodies
to HCV, and the antibodies can take some
months to develop, the doctor may advise the
patient to take a repeat test if they believe
they may have been recently exposed to the
virus.

Treatment for hepatitis C

Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has
improved in recent years, the success rates vary depending on which genotype the patient
has and how long they have had hepatitis C. In 2011, the FDA approved a new drug called
Victrelis (for the treatment of the genotype 1 strain of hepatitis C). When taken alongside
existing drugs, Victrelis cured more than 60 percent of patients in clinical trials compared to
between 20-40 percent of patients when existing drugs were taken alone.3 Unlike other
drugs for hepatitis C, Victrelis is a protease inhibitor, similar to those used to treat HIV.
Adherence to this drug is essential to prevent drug resistance.
The antiviral drugs may cause significant side effects that may be intolerable for some
people. These include:
headaches
flu-like symptoms
nausea
tiredness
body aches
depression
skin rashes
A patient will also require regular check-ups to monitor their progress. It is important to
remember that if HCV treatment is effective and the infection is cleared, this does not mean
the patient has future immunity to hepatitis C.

Prevention
Currently, there is no vaccine for hepatitis C, but research is
in progress. Like HIV, HCV can mutate easily, which makes
vaccine development complicated. As no vaccine exists, all
measures should be taken to prevent HCV transmission.
Injecting drug users should never share any needles,
syringes or mixing spoons, as blood can be transferred
between users.
Infection through penetrative sex does occur, although it is
not common. If a person is infected with HCV, it is advisable for
them to use a condom for penetrative sex to ensure they do
not pass on the virus to their partners through any open
genital cuts or sores.
People should avoid sharing toothbrushes, shaving
equipment (especially razors), or anything else that may be
contaminated with infected blood.
The doctor will advise the patient of any precautions
necessary to avoid infecting others with the virus.

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