hepatitis

Hepatitis A

Hepatitis A, caused by the hepatitis A virus (HAV), is the most common worldwide. It is considered an acute infection and does not give rise to chronic hepatitis. Its onset usually occurs 15 to 45 days after exposure to the virus, and some infected individuals, especially children, exhibit no clinical manifestations. In the majority of cases, no special treatment other than bed rest is required; most recover fully from the disease.

The severity ofHAV can be reduced if the affected individual is injected within two weeks of exposure with immune serum globulin obtained from persons exposed to HAV. This approach, called passive immunization, is effective because the serum contains antibodies against HAV. Havrix, the first hepatitis A vaccine, was introduced in the early 1990s, licensed initially in Europe and later approved in the United States, along with a second vaccine known as Vaqta, the following year. Both vaccines were recommended for individuals ages 12 months and older. HAV vaccination is also recommended for individuals who travel to areas where HAV is common, for those with chronic liver disease or who are affected by hemophilia, and for persons who have an occupational risk for infection.

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Hepatitis B

Hepatitis B is a much more severe and longer-lasting disease than hepatitis A. It may occur as an acute disease or become chronic and lead to permanent liver damage; infection in infancy is associated with a significantly increased risk of chronic disease. Symptoms usually appear from 40 days to 6 months after exposure to the hepatitis B virus (HBV). Those persons at greatest risk for contracting hepatitis B include individuals who use drugs intravenously, sexual partners of individuals with the disease, and health care workers who are not adequately immunized. Testing has significantly reduced the risk of HBV transmission among recipients of organ transplants or blood transfusions. Approximately 1 in 10 patients with HBV infection becomes a carrier of the virus and may transmit it to others. Those who carry the virus are also 100 times more likely to develop liver cancer.

Safe and effective vaccines against HBV are available, including Twinrix, which offers combined protection against HAV and HBV for persons ages 18 and older. The use of HBV vaccines has led to decreases in HBV infection prevalence and has helped to lower the risk of liver cancer caused by chronic HBV infection. Passive immunization with hepatitis B immune globulin can also provide protection.

Hepatitis C

Hepatitis C virus (HCV) was isolated in 1989, at which time it was referred to as non-A, non-B hepatitis. It typically is transmitted through contact with infected blood. Infection may cause mild or severe illness that lasts several weeks or a lifetime. An estimated 50 million people worldwide live with chronic HCV infection. About 80 percent of those who become acutely infected are asymptomatic; those who do show symptoms may experience a flulike illness, with fatigue, nausea, vomiting, and sometimes jaundice. Approximately 60 to 80 percent of chronic infections progress to chronic liver disease, such as cirrhosis or liver cancer. Individuals who drink excess amounts of alcohol and who are infected with hepatitis C are more prone to developing cirrhosis.

Treatment for hepatitis C involves a combination of antiviral medications, namely pegylated interferon alpha and ribavirin. Response rates to these drugs vary according to a number of factors, including treatment regimen, HCV genotype, the severity of liver disease, and the patient’s genetic makeup. Other antivirals, such as boceprevir and telaprevir, may be used along with interferon and ribavirin in patients who are infected with a form of hepatitis C known as hepatitis C genotype 1; this therapy typically is reserved for patients in whom the combination of interferon and ribavirin alone is ineffective. Hepatitis C infection can be prevented by avoiding unsafe blood products, needle sharing, and unprotected sex and by exercising caution when seeking tattoos or body piercings. Despite extensive research, a vaccine to prevent HCV infection has remained elusive.

Hepatitis D

Infection with hepatitis D virus (HDV), also called the delta agent, can occur only in association with HBV infection, because HDV requires HBV to replicate. Infection with HDV may occur at the same time infection with HBV occurs, or HDV may infect a person already infected with HBV. The latter situation appears to give rise to a more serious condition, leading to cirrhosis or chronic liver disease. Interferon alpha is the only treatment for HDV infection. Preventing infection with HBV also prevents HDV infection.

Hepatitis E

Discovered in the 1980s, the hepatitis E virus (HEV) is similar to HAV. HEV is transmitted in the same manner as HAV, and it, too, only causes acute infection. However, the effects of infection with HEV are more severe than those caused by HAV, and death is more common. The risk of acute liver failure from infection with HEV is especially great for pregnant women. In less-developed countries, including Mexico, India, and those in Africa, HEV is responsible for widespread epidemics of hepatitis that occur as a result of ingestion of contaminated water or food (enteric transmission).

Hepatitis F and G

Some cases of hepatitis transmitted through contaminated food or water are attributed to the hepatitis F virus (HFV), which was first reported in 1994. Another virus isolated in 1996, the hepatitis G virus (HGV), is a cause of sexually transmitted and bloodborne cases of hepatitis. HGV causes acute and chronic forms of the disease and often infects persons already infected with HCV.