Written by Dr Yiannis Kallis for Doctify
You may have heard of hepatitis but would you be able to identify it?
Here to talk us through the condition is Gastroenterologist Dr Yiannis Kallis.
What actually is viral hepatitis?
There are many viruses that affect the liver. Several, including common cold and flu viruses, are likely to pass through the liver during the infection period. Most rarely cause any significant problems. There are some viruses, however, which specifically infect and damage the liver. These cause problems like jaundice or chronic liver disease, and occasionally leading to liver failure or cirrhosis. This type of illness is called a ‘viral hepatitis’. There are five different viruses responsible: hepatitis A, B, C, D and E. Each is a separate infection and has its own unique features.
How do you get viral hepatitis?
There are broadly-speaking two different ways in which you can acquire a viral hepatitis. Hepatitis A (HAV) and hepatitis E (HEV) are spread from contaminated food or water, similar to many gastroenteritis illnesses. These are much more common in the developing world than in the UK. Outbreaks of HEV can also occur in the UK, particularly from under-cooked pork meat.
Hepatitis B (HBV) and hepatitis C (HCV) are mainly spread through blood-blood contact. They are viral infections that are extremely common throughout the world. HBV can be passed from mother to child during childbirth. Both HBV and HCV can also be acquired by sharing needles, for example during injection drug use. Blood products in the UK are stringently screened for both viruses and medical equipment is single-use or thoroughly sterilised. However, in many less developed parts of the world both HBV and HCV are commonly spread through blood transfusion or within dental practices, clinics or hospitals.
If you were born or raised in a part of the world where HBV or HCV is common, or if you had medical care there, you may be at risk of having the infection. Sub-Saharan Africa, the Asian subcontinent and Far East Asia are some parts of the world where both viruses are endemic. HBV can often also be sexually transmitted, but sex is a much rarer route of acquisition of HCV. Hepatitis D (HDV), also known as hepatitis delta, is an uncommon infection that can only occur if a patient already has HBV. It is usually spread through blood-blood contact.
What are the symptoms?
The symptoms of a viral hepatitis infection will vary according to the virus and the circumstances. An acute viral infection very often causes jaundice (a yellowing of the skin and eyes, and a darkening of the urine). In addition to this, there are often other more vague symptoms such as fatigue, muscle ache, mild diarrhoea etc. This is usually the case for HAV and HEV, and sometimes the case for HBV. In most cases the illness will pass and the virus will be cleared from the body after a few weeks. However, in rare cases, severe liver injury or even liver failure can ensue. You should thus always seek medical attention if you become jaundiced.
Chronic infection with HBV and HCV, i.e. infection that lasts for many years, frequently does not cause any symptoms. Most people will be unaware they have the virus. For this reason, it is important for people to be tested if they have any of the risk factors for acquisition of these virus. Infection is usually confirmed by a simple blood test. Chronic HBV and chronic HCV are significant health problems in the UK and throughout the world. They are also common causes of liver cirrhosis (end stage liver disease) or liver cancer. Patients diagnosed with a viral hepatitis should be referred to a hepatologist (liver specialist) to manage their condition.
How is it treated and can it be cured?
Acute viral hepatitis infections usually last for a few weeks but are then cleared by the body without treatment. This is the norm for HAV and HEV infection, and also most often the case for acute HBV infection in adulthood. Most people will feel unwell and run-down, and they should make sure they are taking plenty of rest and avoiding alcohol.
Chronic HBV infection lasts for many years. Occasionally people spontaneously clear the virus but most will live with the infection indefinitely, and some will thus develop major liver-related complications as a consequence. Treatment exists to control active infection, but usually needs to be taken long-term.
Many people however do not actually require treatment, for example when the body’s own immune system is effectively controlling the virus. This can be the case for many years. Treatments that can reliably cure chronic HBV infection are still being developed. They are likely several years from being clinically available.
In contrast, highly effective treatments for HCV have emerged over the last few years such that the vast majority of HCV infections can be effectively cured by 2-3 months of tablet therapy with minimal side effects. Chronic HBV and HCV is a highly specialised and evolving area of medicine so patients with these infections should be under the care of a hepatologist to treat/control their infection and manage any liver-related complications.
Further good news is that effective vaccines exist for some of the hepatitis viruses (HAV and HBV), and they are widely available at GP surgeries and travel clinics.
Can you lessen the effects of hepatitis with lifestyle changes?
As always prevention is better than cure, so people should take care to avoid exposing themselves to undue risk of catching viral hepatitis. This would include reducing exposure in high risk scenarios such as using condoms during sex, avoiding sharing needles and razor blades, and only having tattoes, piercing etc. or undergoing medical treatments in reputable establishments. All expectant mothers should have testing for HBV and HCV during routine antenatal care. Travellers to high-risk areas, particularly those in the developing world, should be careful to only eat food hygienically prepared and only drink clean bottled water. Similarly, be sure to only eat well-cooked pork meat, when barbecuing your sausages in the summertime!
Patients with chronic HBV and chronic HCV infection can reduce the chance of further harm to their liver with simple lifestyle measures. Most important is not to drink alcohol to excess. The maximum recommended safe amount is 14 units a week, but it is probably sensible to drink even less if you have viral hepatitis. Likewise, maintaining a healthy weight by exercising regularly and not overeating will reduce the risk of fat deposition in your liver. This will also help to look after your liver well-being. And make sure that you see your liver specialist at least once or twice a year!
