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Hepatitis B and C

The Liver

The liver is the largest organ in the body. It is found high in the right upper abdomen, underneath the ribs. It is a very complex organ and has many functions. They include:

  • Storing energy in the form of sugar (glucose)
  • Storing vitamins, iron, and other minerals
  • Making proteins, including blood clotting factors, to keep the body healthy and help it grow
  • Processing worn out red blood cells
  • Making bile which is needed for food digestion
  • Metabolizing or breaking down many medications and alcohol
  • Killing germs that enter the body through the intestine

The liver is subject to illnesses, such as hepatitis B, which may lead to serious liver damage.

When cells in the body are injured by such things as chemicals or infection, the area that is injured becomes inflamed. Hepatitis is inflammation of the liver, which in turn causes damage to individual liver cells. It is most often caused by viral infection. However, it can also be caused by alcohol, certain drugs, chemicals or poisons, or other diseases.

Hepatitis may be either acute or chronic. In acute hepatitis the inflammation develops quickly, and lasts only a short period of time. The patient usually recovers completely, but it can take up to several months. Occasionally, a person fails to recover fully, and the hepatitis becomes chronic. Chronic hepatitis can develop over a number of years without the patient ever having acute hepatitis or even feeling sick. As the liver repairs itself, fibrous tissue develops, much like a scar forms after a cut or injury to the skin heals. Advanced scarring of the liver is called cirrhosis. Over time, cirrhosis irreversibly damages the liver, eventually ending in liver failure.

Hepatitis B is caused by the hepatitis B virus (medically abbreviated as HBV). Current estimates are that over 250,000 people in the United States contract HBV each year. It is often spread through sexual contact, accounting for about 50% of the reported cases. It is also spread through contact with blood or body fluids from a person carrying HBV. Some groups have a higher risk of becoming infected with HBV. These include:

  • Intravenous drug users
  • Health care workers, funeral workers, police
  • People in an HBV infected person’s household
  • People with multiple heterosexual or, especially, homosexual partners
  • Residents of nursing homes
  • Hemophiliac and hemodialysis patients
  • Prisoners and prison workers
  • Travelers to underdeveloped countries
  • Certain ethnic groups such as Asians, Hispanics, American Indians, Alaskan Natives, or people from developing countries

In pregnancy, the virus is passed from an infected mother to her child in about 90% of the cases. This usually occurs during delivery. HBV is also carried in breast milk. In about 30% of all cases of hepatitis B, however, it is unknown how the patient contracted the virus.

HBV is much more contagious than the AIDS virus. For example, it can live outside the body on a dry surface for up to 10 days. Once a person gets the virus, it may take from one to six months for the infection and symptoms to develop. One of three things can then happen—most patients develop acute Hepatitis B and recover completely; a small percentage become HBV carriers; and some develop chronic hepatitis B.

Many patients with acute hepatitis B have no symptoms, or the symptoms are mild and often mistaken for flu. Their bodies are able to fight the virus off quickly. Some, however, can become quite sick while their bodies are fighting off the virus. The following are symptoms of acute hepatitis B:

  • Loss of appetite, nausea, vomiting, fever
  • Aching muscles and sometimes joint pain
  • Tenderness in the right upper abdomen
  • Jaundice (yellowing of skin and eyes)
  • Tea-colored urine; putty-like or white stool

Diagnosis of the disease is made by a blood test. It is called the hepatitis B surface antigen test (HBsAg). No specific treatment is available or usually necessary for acute hepatitis infection. The physician may recommend supportive measures to help the patient maintain strength and avoid taxing the liver while the body’s natural defenses are fighting the virus. Acute hepatitis B patients recover completely within six months and develop antibodies that give them a life-long immunity.

Some patients who become infected, however, do not recover completely. Up to 10% of adults with Hepatitis B and up to 50% of infected children under five years of age are not able to completely fight off the virus within six months. This occurs because their bodies are unable to develop antibodies against hepatitis B. Most of these patients become HBV carriers.

Hepatitis C is caused by a virus (medically abbreviated as HCV). This type of viral hepatitis is different from the others in an important way. All patients with hepatitis A and most with hepatitis B develop an acute infection, recover completely, and develop antibodies that protect them from ever getting the disease again. Once inside the body, it changes its form to evade discovery and attack by the immune system. Scientists have already identified many forms of HCV, and patients infected with one type are not necessarily safe from other types. Hepatitis C patients do develop antibodies, but they are not curative or protective as in hepatitis A or B. Hepatitis C antibodies may not completely rid the body of the virus. Therefore, most people infected with the HCV virus will develop chronic hepatitis.

Current estimates are that 3.5 million Americans carry the virus that causes hepatitis C, and 150,000 people become infected with HCV each year. This virus is known to be spread through infected blood, blood products, and needles. Prior to the late 1980s, people were most at risk for contracting the disease through blood transfusions. However, a blood test was developed at that time to detect the virus, and the blood supply is now always tested to prevent spread of the disease in this way. Even so, there is a very slight risk for those who must receive blood products on a regular basis, such as hemophiliacs and patients on hemodialysis. Health care workers are also at risk. At this time, the people most at risk for getting hepatitis C are IV drug users who share needles. There are also a larger number of cases among East Asians. In about 40% of all cases of hepatitis C, it is unknown how the patient was infected with the virus. This situation is known as community acquired disease.

Hepatitis C is a cause for concern for two reasons. First, most cases become chronic. Second, patients seldom become acutely ill, so it is possible for them to have the disease for some time before it is diagnosed. Late in the disease, fatigue may become increasingly severe. If cirrhosis has developed, other more serious symptoms may occur. However, the elevation in the blood ALT may not correlate with the degree of liver inflammation. In other words, a high ALT may not necessarily mean there is a serious degree of inflammation. Conversely, a low or normal blood ALT level may be present even though there is chronic liver damage. For this reason, a liver biopsy is almost always required to determine how serious the disease may be. Under. A biopsy can show if cirrhosis is present and how far it has progressed. It is believed that about 20% of the patients with chronic hepatitis C will develop cirrhosis, and a few of those will go on to develop liver cancer. It may take from 10 to 40 years for serious liver damage to occur.

Hepatitis B

HBV carriers recover from the infection completely and feel healthy. They have no ongoing hepatitis or liver damage. However, their blood tests show they still have the virus and have not developed hepatitis B antibodies. Therefore, they can pass on the virus. This is called an HBV carrier, because carriers do not develop symptoms or feel sick, thousands of people who become carriers of HBV never know it. There may be as many as one million Americans carrying HBV.

There is no treatment presently available for this situation. Carriers have a responsibility to practice safe lifestyle habits that will prevent their passing the virus on to others. This especially includes protected sex.

Hepatitis C

Certain people infected with HCV have a positive HCV blood test, but a normal liver enzyme test. These individuals are often called HCV carriers, and they can pass the virus on to others.

Although they appear not to be seriously ill, there is recent evidence that even these people may have chronic hepatitis. Therefore, each should be evaluated by a liver specialist.

The risk of transmitting HCV sexually is low compared to hepatitis B and AIDS. In marriages and long-term relationships with monogamous partners, it is often the case that one person is HCV positive and the partner is HCV negative. The current medical recommendation is that in these circumstances, sexual practices need not be changed. However, when people have multiple sex partners or new partners, they should never engage in unprotected sex.

It appears that in pregnancy, HCV is passed on to the fetus less than 5% of the time. It may depend on how high the mother’s blood virus level is during pregnancy. Therefore, hepatitis C infected women should always consult with their physicians before becoming pregnant.

Hepatitis B

There is a safe and effective vaccine to protect or immunize a person against hepatitis B. The vaccine usually offers protection for about 10 years or more. However, it is of no use to those already infected with HBV. Persons who have not been vaccinated and who know they have been exposed to HBV should receive an injection of hepatitis B immune globulin within two weeks of exposure to the virus. This is called a passive immunization. It gives immediate short-term protection for 3-6 months. The Hepatitis B vaccine is active immunization. Active immunization provides long-term (sometimes lifelong) protection. Therefore, people who are at risk of coming in contact with the virus, and especially newborn infants and sexually active teenagers, should be immunized. In the U.S., pediatricians now recommend that all children be actively vaccinated.

There are other precautions people should take to protect themselves against hepatitis B. Since the virus is most often spread through sexual contact, it is most important to avoid unprotected sex with those who have or are likely to have the infection. Precautions must be taken to avoid coming in contact with blood or body fluids from an infected individual. For those living in households with infected patients, surfaces which may hold the virus should be cleaned with one part household bleach to 10 parts water. Items such as razors, toothbrushes, IV needles or pierced earrings should never be shared. People should also avoid such practices as tattooing and ear piercing in places where sterile conditions are questionable. Women who are pregnant should be tested for HBV and follow their physicians’ advice to protect their unborn children.

Hepatitis C

There is no vaccine currently available to protect against hepatitis C, as there is with hepatitis A and hepatitis B. People can prevent getting hepatitis C by not sharing anything that is likely to hold and transmit blood—razors, manicure tools, toothbrushes, and especially IV drug needles. Practices such as ear piercing and tattooing should be avoided in places where sterile conditions are questionable. Until all circumstances under which HCV can be transmitted have been thoroughly identified, it should be assumed that every person with hepatitis C can pass the virus on to others. Therefore everyone, especially health care workers, should avoid coming in contact with blood and body fluids from infected individuals.

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