What is hepatitis?
Hepatitis is an inflammation of the liver. Most forms of hepatitis result from infection with hepatitis virus A, B or C. Damage to the liver from alcohol, toxins, and certain drugs can also result in hepatitis. Some inherited diseases can cause hepatitis, along with prolonged obstruction of bile flow. There is also an autoimmune form of hepatitis. Some forms of hepatitis produce mild symptoms, while others can be serious or life-threatening.
The liver is an accessory organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medications, alcohol and drugs; and controlling fat storage and cholesterol production and release. The liver is one of our ‘vital’ organs because humans cannot survive if the liver fails.
The severity, treatment and outcome of hepatitis depend largely on the type of hepatitis you have. The initial symptoms of hepatitis are similar to flu (influenza virus infection), but with the addition of jaundice, a yellowish discoloration of the skin and whites of the eyes.
Left untreated, hepatitis will begin to interfere with liver function and may progress to end-stage liver disease and liver failure. Drinking alcohol worsens the liver damage caused by hepatitis viruses and other forms of hepatitis. Fortunately, vaccines have been developed to protect against hepatitis A and B, and there are curative treatments for hepatitis C.
Seek immediate medical care (call 911) for serious symptoms associated with complications of hepatitis, such as confusion, hallucinations, problems with memory, extreme fatigue, fainting, fever (especially if combined with a swollen abdomen), or vomiting blood.
Seek prompt medical care if you experience any of the following symptoms, including yellowing of the skin and eyes; abdominal pain; nausea, vomiting or diarrhea; constant weakness or dizziness; difficulty thinking or understanding; and low-grade fever. Also seek prompt medical care if you are being treated for hepatitis but your symptoms persist or recur.
What are the different types of viral hepatitis?
Viral hepatitis is the main form of hepatitis in the United States and around the world. The six hepatitis viruses that infect the liver are contagious in different ways:
- Hepatitis A virus (HAV) usually spreads by fecal-oral contact or from ingesting food or water contaminated with feces from an infected person. The virus can also be transmitted through sexual contact with an infected person. There were 12,474 new cases in 2018. Outbreaks among drug users and homeless populations have contributed to rising HAV numbers since 2011. A vaccine is available.
- Hepatitis B virus (HBV) spreads by exposure to infected or contaminated blood (usually from needles), semen, vaginal secretions, or saliva. Incidence is increasing among unvaccinated middle-aged adults due to intravenous drug use and multiple sex partners. There were 3,322 new HBV cases reported in 2018. About 860,000 people are living with chronic hepatitis B infection, but it may be as high as 2.2 million because most people do not know they have chronic disease. Asian Americans and Pacific Islanders are affected much more than Caucasian populations, making up about half of people living with chronic HBV. A vaccine is available.
- Hepatitis C virus (HCV) spreads primarily from infected blood (such as needles), but it can also occur from sexual contact with an infected person or from an infected mother to her baby. More than half of cases become chronic. There were 4,768 new hepatitis C cases in 2018. An estimated 2.4 to 4.7 million people are living with chronic HCV (including 23,000 to 46,000 children). The rise in new cases in recent years is driven, in part, by increased heroin use fueled by the opioid epidemic. There is no vaccine for hepatitis C; however, HCV-specific antiviral medications can cure most hepatitis C infections.
- Hepatitis D virus (HDV) spreads like HBV and can occur only in the presence of HBV infection. Coinfection of HBV and HDV increases the risk of liver failure.
- Hepatitis E virus (HEV) spreads through the fecal-oral route. It is rare in the United States.
- Hepatitis G virus (HGV) spreads through contaminated blood and sexual contact, typically in conjunction with hepatitis B or C virus infection. Although HGV is related to hepatitis viruses, its role in causing liver disease is not yet clear. HGV is detectable in about 1.5% of U.S. blood donors.
What does acute and chronic hepatitis mean?
Acute hepatitis means the symptoms come on suddenly and may be severe. Acute hepatitis is quite common in the United States. Its causes include infection with viral hepatitis A, B, C, D, or E; overdose of drugs, such as acetaminophen; and chemical exposure. Some people do not recover fully from acute hepatitis and develop chronic hepatitis, as the liver continues to sustain progressive damage.
Doctors consider hepatitis chronic if symptoms persist longer than six months. Chronic hepatitis can last years, even a lifetime, and increases an individual's risk of liver cancer. People with chronic viral hepatitis, including hepatitis B and C, must take precautions to prevent spreading the disease to others through sexual contact and contaminated blood.
What are the symptoms of hepatitis?
For most people, symptoms of hepatitis are similar to flu, but with the addition of jaundice (yellowing of the skin and eyes). Jaundice is caused by an excess of bilirubin in the blood as a result of mild liver dysfunction.
Common symptoms of hepatitis
Some people have hepatitis but exhibit no symptoms. For others, any of these symptoms may become severe:
- Abdominal pain
- Low-grade fever
- Malaise and lethargy
- Nausea with or without vomiting
- Urine that is dark yellow
- Yellowing of the skin and whites of the eyes (jaundice)
Course of viral hepatitis
The main types of viral hepatitis differ in their course:
- Hepatitis A symptoms develop soon after exposure to the virus. Adults and older children are likely to have symptoms; babies are less likely to have symptoms. The infection generally resolves within two months.
- Hepatitis B symptoms develop within six months of exposure. Many people do not experience symptoms, but sometimes they are severe enough to require bed rest or hospitalization. Most adults recover well from the acute phase of infection, but about 5% of infected adults develop chronic HBV. A subset are carriers, in which patients have antibodies against HBV but barely detectable virus. This state can last for months to years—even a patient’s lifetime—without reactivation of the virus. Unfortunately, most infected infants develop chronic HBV.
- Hepatitis C also has an acute phase, which begins 2 to 12 weeks from exposure. There are usually no symptoms. The body cannot clear hepatitis C virus on its own, so the infection becomes chronic. Today’s treatments can cure HCV in most cases.
Serious symptoms that might indicate a life-threatening condition
In some cases, complications of advanced, uncontrolled hepatitis, such as cirrhosis, can be life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Abdominal swelling, distention or bloating
- Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
- Severe abdominal pain
- Severe fatigue
- Vomiting blood or black material (resembling coffee grounds)
What causes hepatitis?
There are numerous causes of inflammation of the liver, with viral infections being a common cause.
Common hepatitis causes:
- Alcoholic hepatitis, caused by chronic heavy drinking. Alcoholic liver disease is also correlated with hepatitis C infection.
- Autoimmune hepatitis, caused by an abnormal immune attack against the liver. The underlying trigger of autoimmune hepatitis is not known. About 70% of cases are in females. Autoimmune hepatitis is a chronic disease; there is no cure, but immunosuppressants can reduce symptoms.
- Nonalcoholic steatohepatitis (NASH), caused by nonalcoholic fatty liver disease, a condition related to obesity, high cholesterol, and high blood pressure. NASH affects 2 to 5% of North Americans.
- Toxic hepatitis, caused by poisons and chemicals, including medications and herbal supplements. Drugs that can cause hepatitis include acetaminophen, nonsteroidal anti-inflammatory drugs, anabolic steroids, birth control pills, statins, methotrexate, certain antibiotics and antifungals, and tuberculosis treatments.
- Viral hepatitis, caused by infection with a hepatitis virus. Hepatitis C is the most common form of viral hepatitis.
Other hepatitis causes include:
- Alpha-1 antitrypsin deficiency (an inherited condition that predisposes to liver and lung damage)
- Hemochromatosis (a genetic disorder characterized by excess iron in the body; may be inherited)
- Decreased blood flow to the liver, which causes ischemic hepatitits (heart failure or respiratory failure can lead to this form of hepatitis)
- Primary biliary cirrhosis (bile duct autoimmune disease that also damages the liver)
- Primary sclerosing cholangitis (a bile duct disease that also damages the liver)
- Wilson’s disease (an inherited disease leading to excess copper deposition in the body)
What are the risk factors for hepatitis?
Hepatitis risk factors vary depending on the type of hepatitis.
For hepatitis A, which typically spreads by food and water contaminated with feces from an infected person but can also occur through sexual activity with an infected person, risk factors include:
- Being homeless
- Having sex with an infected person (not only oral-anal sex)
- If male, having sex with other males
- Poor sanitation and reduced or no access to clean water
- Travel to an area with high rates of hepatitis A and not being immunized
- Working or living in a communal setting
For hepatitis B, which spreads by contaminated blood (usually from needles), semen, vaginal secretions, or saliva, risk factors include:
- Being born to an infected mother
- Exposure to needles, including tattoo needles, used by an infected person
- Living with or caring for someone who has HBV
- Needing dialysis
- Participating in high-risk activities, such as intravenous drug use and unprotected sex with multiple sex partners
For hepatitis C, which spreads primarily by contaminated blood but can also spread through sex, risk factors include:
- Being born to an infected mother
- Exposure to needles, including tattoo needles, used by an infected person
- Needing dialysis
- Participating in high-risk activities, such as intravenous drug use or unprotected sex with multiple sex partners
Some people living today with hepatitis C were infected from a contaminated blood transfusion received before 1992. Blood is now screened for hepatitis C.
Risk factors for other types of hepatitis
Risk factors for acquired forms of hepatitis include:
- Alcoholic hepatitis risk factors include chronic alcohol abuse and alcoholism (alcohol dependency). (Alcoholic hepatitis is a type of toxic hepatitis.)
- Nonalcoholic steatohepatitis risk factors include obesity, type 2 diabetes, high cholesterol, high blood pressure, and living a sedentary lifestyle.
- Toxic hepatitis risk factors include anabolic steroid abuse and medication and supplement overuse or overdose.
How do you prevent hepatitis?
Preventive measures vary by the underlying cause of hepatitis. You cannot prevent autoimmune hepatitis or inherited diseases that increase the risk of hepatitis. For hemochromatosis-related hepatitis, donating blood periodically to reduce your blood iron level will prevent a toxic buildup of iron and protect your liver (and other organs).
Viral hepatitis prevention
You may be able to lower your risk of viral hepatitis by:
- Avoiding contact with blood or body fluids (including feces) of an infected person
- Avoiding contact with used needles, including tattoo needles
- Avoiding contact with utensils, bedding, clothing, or personal items used by someone infected with hepatitis
- Avoiding raw seafood/shellfish
- Boiling any water that might be contaminated before drinking it or using it to brush your teeth
- Getting vaccinated against hepatitis A and B
- Limiting travel in places with sanitation deficiencies
Contact your healthcare provider about getting vaccinated for hepatitis A and hepatitis B (HBV vaccination is part of a child’s vaccination schedule).
Noninfectious forms of hepatitis
You may be able to reduce your risk of noninfectious forms of hepatitis:
- To prevent nonalcoholic steatohepatitis (NASH), maintain a healthy lifestyle and treat NASH risk factors, such as type 2 diabetes, high blood pressure, and obesity.
- To prevent alcoholic hepatitis, keep alcohol consumption to a minimum. For males, that means no more than two drinks per day; for females, no more than one drink per day. If you drink a lot and are struggling with quitting or cutting back, talk with a licensed healthcare provider or an addiction counselor about effective ways to curb your drinking habit.
- To prevent toxic hepatitis, do not take more than the recommended dose of medications and supplements, do not take anabolic steroids, and protect yourself if you work with chemicals known to injure the liver, including vinyl chloride, polychlorinated biphenyls, and the herbicide paraquat. If you develop toxic hepatitis, stopping your exposure to or use of the substance will usually resolve symptoms.
How do doctors diagnose hepatitis?
Doctors mainly use blood tests and a physical exam to diagnose hepatitis. This includes your personal and family medical history. The most telltale sign of hepatitis is jaundice—a yellow cast to the skin and whites of the eyes. This is due to increased levels of bilirubin, a yellow substance, in your blood and tissues. Jaundice is the most visible clue to liver inflammation, along with dark urine and pale (nearly white) stool. (Gallbladder and bile duct problems can also cause jaundice.)
A diagnosis of hepatitis may be delayed because the many other possible symptoms—such as abdominal pain, fatigue, nausea, and loss of appetite—are shared with many other, less serious conditions and may be ignored.
If your doctor suspects you have hepatitis, he or she will order these blood tests:
- Complete blood count to evaluate your blood health
- Liver function tests (liver panel) to evaluate markers of liver inflammation and damage, including liver enzymes, total protein, and bilirubin
- Virology tests to diagnose the specific type of viral hepatitis
Other tests your doctor may order include:
- Autoimmune antibody panel to help diagnose autoimmune hepatitis
- Genetic analysis for genetic and inherited conditions that can lead to hepatitis, such as Wilson’s disease and hemochromatosis
- Toxicology tests, including ethanol and drug testing
How is hepatitis treated?
There is no specific treatment for liver damage, but treating the underlying cause, such as infection, can prevent or stop further damage. The liver has the capacity to regenerate damaged tissue, but it takes time. Left untreated, continued damage and regeneration changes the structure of the liver and is the basis of cirrhosis.
For any form of hepatitis, you should stop drinking alcohol. Also, discontinue use of drugs, medications and supplements that may further damage the liver, such as acetaminophen (Tylenol) and drugs that increase your risk of bleeding, such as aspirin. Only take essential medicine under your doctor’s guidance.
Some types of hepatitis can only be treated with general supportive measures, such as getting rest and drinking plenty of fluids until the disease runs its course. For autoimmune hepatitis, doctors typically prescribe medication to suppress the immune system. For toxic hepatitis, including alcoholic hepatitis, discontinuing your use or exposure to the substance will relieve symptoms.
Viral hepatitis treatment
Many antiviral drugs have been developed, and new ones continue to be approved for the treatment of viral hepatitis. Viral hepatitis treatments include:
- Hepatitis A may not require treatment if the symptoms are mild. In cases of possible or known exposure to the virus, the hepatitis A vaccine should be administered within 2 weeks of exposure to prevent serious illness.
- Hepatitis B will run its course, as there is no treatment. Severe hepatitis B and liver damage may require hospitalization. Chronic HBV may respond to antiviral medicine (which you take for life), but the medicine does not cure it. In cases of possible or known exposure, an injection of special antibodies (immunoglobulins) within 12 hours may help lessen symptoms. Patients should receive the hepatitis B vaccine at the same time.
- Hepatitis C can be cured in about 90% of cases with an 8- to 12-week course of HCV direct-acting antiviral (DAA) medication. (These medications do not work against HBV.) There is no vaccine for HCV.
Untreated or poorly controlled liver inflammation can progress to end-stage liver disease or liver failure. Liver transplant may be an option for people with severe liver damage and liver failure.
Lifestyle and self-care tips for hepatitis
Strategies to help you recover, improve your prognosis, and protect those around you include:
- Abstaining from alcohol and other toxic substances
- Eating a well-balanced diet low in fat
- Monitoring your liver function as recommended by your physician, which may include blood tests and liver ultrasound or other imaging
- Protecting your household members and sexual partners from infection if you have viral hepatitis
- Rest (you may too tired to work or go to school)
- Taking medications only as necessary and prescribed by your physician
How does hepatitis affect quality of life?
Some types of hepatitis resolve on their own or with treatment and have little impact on quality of life, but hepatitis B and C can become chronic. Autoimmune hepatitis and NASH are also chronic diseases. Although most cases of chronic HCV can be cured, other types of chronic hepatitis require lifelong treatment.
Both chronic hepatitis B and C are associated with reduced quality of life, but advances in treatment are improving life for many people with these diseases. Studies of HCV patients show the patient’s social and economic status, rather than disease severity itself, correlates with how they perceive their quality of life. Patients receiving HCV therapy report improved quality of life. Patients with chronic HBV who respond well to HBV antiviral therapy score themselves better on questions for physical health-related quality of life compared to before therapy.
What are the potential complications of hepatitis?
Complications of untreated or poorly controlled hepatitis can be serious and fatal. You can help minimize your risk of serious complications by following the treatment plan that you and your healthcare professional design specifically for you.
Complications of hepatitis include:
- Cirrhosis (scarring of the liver that causes severe dysfunction)
- Cryoglobulinemia (presence of abnormal proteins in the blood that can cause inflammation of the blood vessels)
- Fibrosis of the liver (development of fibrous tissues that interfere with liver function)
- Hepatic encephalopathy (brain disorder caused by liver disease)
- Liver cancer
- Liver failure
- Portal hypertension (increased blood pressure in the veins around the liver, stomach and esophagus)
Does hepatitis shorten life expectancy?
Most cases of hepatitis have a good prognosis with a full recovery. People with chronic hepatitis have a poorer prognosis.
A small percentage of hepatitis B infections become chronic infections, but more than half of people infected with hepatitis C virus develop chronic hepatitis. Because many people with HCV do not experience symptoms until the disease is advanced, doctors recommend people with risk factors get tested for HCV. (The CDC recommends one-time HCV testing for all adults and all pregnant females with every pregnancy.)
Most deaths from viral hepatitis occur from chronic disease after years of accumulated liver damage. In addition, hepatitis B and hepatitis C are the leading causes of liver cancer. U.S. rates of liver cancer are increasing, as are deaths from liver cancer. People with chronic HBV die up to 14 years earlier than the general population.
HCV antiviral treatment, first approved in 2011, can cure most infections. However, HCV-specific antiviral therapy has not yet changed the life expectancy of people with HCV compared to people without HCV, which appears to be about 12 years longer (based on a large population-based study before and after HCV antiviral approval). Factors that negatively affect HCV prognosis and life expectancy include being male, using alcohol, and coinfection with other viruses.
In 2018, the most recent data year available, there were:
- 171 deaths from hepatitis A
- 1,649 deaths from hepatitis B
- 15,713 deaths from hepatitis C
People can protect themselves from hepatitis A and B with available vaccines and by taking precautions to prevent hepatitis C infection. Hepatitis Awareness Month is May.