ABCS OF HEPATITIS: FROM CHRONIC TO CURABLE, WHAT YOU NEED TO KNOW
This article was medically reviewed by Dr. Fazila Aslam.
Though not uncommon, viral hepatitis is a serious illness that is often less understood than other infectious diseases. Hepatitis A, B, and C are types of viral hepatitis and share some common symptoms, but they infect different patient populations. The different strains are caused by different viruses, and are transmitted and treated in different ways. Each hepatitis variant must be identified by a blood test so it can be properly treated, and viral hepatitis should never be ignored as it can cause serious health consequences.
What is Viral Hepatitis?
From the Greek hÄpatos for liver and -itis for inflammation, hepatitis primarily affects the liver, one of the body’s largest organs that is essential to good health. In a recent interview, Dr. Fazila Aslam of ID Care described a healthy liver function as one that “rids the body of toxins, prevents and fights infections, regulates blood sugar, and processes nutrients. As such, it’s very important.”
Hepatitis can happen because of certain medications, toxins, heavy alcohol use, and some medical conditions, but the communicable forms in the U.S. are due to viruses known by their letter designations: A, B, C, D, and E. Hepatitis A, B, and C are the most common in the U.S.
Is Viral Hepatitis Curable?
The disease is either manageable or curable depending on which type of hepatitis a person has. Hepatitis A usually resolves itself within a few months; hepatitis B can be suppressed with antiviral drugs until it leaves the body; and hepatitis C can be cured outright with medication.
Dr. Aslam advises that “preventing the disease is always preferable to curing it after infection, so vaccination for type A and B are important, and avoiding contact with infected people and contaminated body fluids, food, and water will inhibit the spread of all forms of viral hepatitis.”
Hepatitis A Virus (Hep A or HAV)
Hepatitis A or HAV is virus that spreads through the oral-fecal route. Contaminated food can infect you, or if you travel to an area where it’s very common, you could get it from contaminated water. If somebody in your home has it, you can get it through household contact. It’s also common in men who have sex with men, so there is a risk of sexual transmission.
The incubation period for HAV is roughly a month, and most of the time, it resolves itself. Fewer than 1% of cases will go on to develop fulminant, or severe, hepatitis, which can result in very bad liver disease and damage.
There’s no antiviral medicine that can cure hep A, so treatment focuses on reducing symptoms via fluids and bed rest.
Prevention is the ideal strategy and easily accessible through the HAV vaccine, delivered in two doses, six to 12 months apart. “Everyone from 12 months to 60 years of age should get the vaccine,” said Dr. Aslam, “it’s by far the best way to avoid problems with this disease.”
Hepatitis B Virus (Hep B or HBV)
Hepatitis B or HBV is a virus that impacts about a million people in this country. The incubation period is between 3 and 6 months, but because it can be asymptomatic, most people do not know when they have it. While some people will recover from hep B, for others it becomes a chronic disease.
HBV spreads through contaminated blood or body fluids, so you can get it from sexual contact, infection passed from childbirth, and household contacts such as the sharing of razor blades. HBV can live outside the body for up to seven days, remaining infectious and it is highly contagious.
There is treatment for hep B, including drugs aimed at suppressing the virus and monitoring to protect the liver, but there is no cure. The medicine suppresses the virus to prevent liver damage such as cirrhosis or liver cancer. Regular ultrasounds can help manage the disease to prevent it from progressing and to detect any cancer in the early stages.
“There is a lot of work being done in the HBV arena, and the hope is that, in the next two to five years, a treatment will become available,” Dr. Aslam said.
Prevention comes in the form of 3 shots at 0, 1, and 6 months apart. Dr. Aslam recommends that “everybody up to the age of 60 should be vaccinated for hepatitis B.”
Hepatitis C Virus (Hep C or HCV)
Hepatitis C or HCV is the most common type of hepatitis and affects approximately 1% of the U.S. population or more than 3 million people, with more than half remaining undiagnosed. “Many people have it and don’t know because hepatitis C can lie dormant for years and emerge as a chronic disease later in life,” explained Dr. Aslam. “It is the number one reason for liver transplants in the U.S., and the number one cause of liver cancer. The big news, however, is that hep C is now curable through a combination of pills taken once a day for eight to 12 weeks. “Because hepatitis C is a primary cause of liver transplants — which are major, resource-intensive operations — being able to stop the disease before it reaches that stage removes a large burden from the whole healthcare system,” Dr. Aslam said. “Treating this disease without a liver transplant represents a big advance.”
Unfortunately, there is still no vaccine for hep C, so it continues to spread mostly through contaminated blood products. Risk factors include sharing needles, using IV drugs, undergoing dialysis treatments, and having received a blood transfusion or organ transplant prior to 1992, when hepatitis screening of donated blood went into effect. Sexual contact is not a prominent route of infection, but it can sometimes happen.
Acute vs. Chronic Hepatitis
Acute hepatitis refers to inflammation of the liver and liver damage that happens over the course of less than six months, and it is most associated with hepatitis A. When patients recover, their liver function blood tests return to normal. Hepatitis B and C cause mostly chronic disease, which produces symptoms and liver damage over longer than six months.
Hepatitis Symptoms in Men and Women
For both men and women, viral hepatitis can cause nausea, vomiting, abdominal pain, and jaundice, which is yellowish discoloration of the skin and the whites of the eyes. According to Dr. Aslam, “you can have fevers, your urine will be dark, your stool will be pale, you can have joint pain, and with hepatitis B and C, you can develop a rash. Sometimes the B and C strains can affect the kidneys, as well.” If advanced liver disease develops, other systemic complications may crop up, such as blood clotting difficulty and fluid retention in the belly.
If you experience these ongoing symptoms with no other obvious cause, talk to your doctor about getting tested for viral hepatitis. Early detection and treatment offer the best chance of a speedy recovery. ID Care has a team of infectious disease experts that specialize in viral hepatitis diagnosis and treatment to ensure optimal health outcomes.
Who is Most at Risk for Viral Hepatitis?
For hep A, those most at risk are travelers to areas where the disease is prevalent.
For hep B, high-risk groups include homeless people, men who have sex with men, incarcerated people, and drug users. Having multiple sex partners or unprotected sex can also be a risk. Blood products can transmit the disease, but not so much in the U.S., due to routine screening of donated blood.
“For hepatitis C in the U.S.,” Dr. Aslam said, “IV drug use and needle sharing are the big causes. If you got a blood transfusion or an organ transplant before 1992, when hepatitis virus screening began, you should get tested because you are at higher risk.”
Prevalence of Hepatitis in USA and New Jersey
In its 2019 Viral Hepatitis Surveillance Report, the CDC estimates that 37,700 acute cases of HAV occurred, as well as 20,700 cases of HBV, and 57,500 cases of HCV. Between 2015 and 2019, hepatitis A infections increased by a whopping 1,325%. Roughly a million people in the U.S. are currently living with the hepatitis B virus, and about three million have hepatitis C. Because viral hepatitis transmission correlates with illicit drug use, in areas and age groups where opioid use is high, rates of hepatitis are also elevated.
Dr. Aslam explained that “the focus for us is on hepatitis C, mostly because we can treat it, cure it, and eliminate it.” While this disease is common in New Jersey, the state doesn’t rank in the CDC’s top 10 according to incidence.
How Hepatitis A, B, and C Spreads
Hepatitis A moves mostly through the oral-fecal route or through contaminated food and water, commonly in areas where the disease is prevalent. Imprisoned people, homeless people, and those living in generally compromised conditions are at higher risk. The disease can move through day-care centers and schools as well.
Hepatitis B is contagious via contact with contaminated body fluids. It could be sexual contact, or through blood or the sharing of needles. High-risk populations include people on dialysis, and babies born to mothers with the disease (known as vertical transmission.)
Hepatitis C is mostly a blood-borne infection, so the risk is heightened during IV drug use, unsanitary tattoo application, and passing it on through childbirth. Sexual transmission occurs, but rarely. Those who’ve had blood transfusions or organ transplants before July of 1992 should also be screened for hep C.
Dr. Aslam advises that “the sexual transmission of hepatitis is most common with the A and B strains, but those who are HIV positive and already relatively immunosuppressed can be at high risk for catching any viral hepatitis and should take extra precautions to avoid infection.”
Preventing Viral Hepatitis
Without question, the best way to prevent infection from hepatitis A or B is to get vaccinated. While there is no vaccine for hepatitis C yet, all hepatitis spread can be reduced by understanding where the virus lurks – whether in blood, other body fluids or on surfaces – and employing these common infection control practices:
- Regularly wash your hands, particularly before cooking or eating food and after using a toilet.
- Avoid direct contact with infected people, including sexual contact.
- Infected people should not prepare food for others.
- When travelling to places with hepatitis outbreaks, follow local safety precautions.
Vaccines are best administered in the offices of infectious disease specialists like those at ID Care but can sometimes be obtained through pediatricians or primary care doctors. Dr. Aslam recommends first checking with your doctor, because the vaccines require enhanced storage techniques, and not every general practitioner or pediatric office will keep them in stock. “At ID Care, we always have some on hand and have the expertise to screen and evaluate every patient properly,” she added.
How is Viral Hepatitis Diagnosed and What is a Hepatitis Panel?
“To diagnose this disease, we use a pretty straightforward blood test,” said Dr. Aslam. “It’s known as a hepatitis panel, and it checks for hepatitis A, B, and C antibodies. It’s fairly effective and not very invasive.”
Testing is indicated if someone has gastrointestinal symptoms like nausea, vomiting, and abdominal pain, or if the patient is jaundiced or is in the hospital for some other reason and lab tests show abnormal liver function. “We do a hepatitis panel to make sure a patient is not suffering from something other than what brought them in,” Dr. Aslam said. “It’s mostly done as a part of a general work-up if the patient doesn’t feel well and their liver function is not that great.”
How Does ID Care Diagnose and Treat Viral Hepatitis Patients?
“We see all three main kinds of hepatitis A, B, and C in our offices,” said Dr. Aslam, “mostly due to referrals from hospitals, primary care physicians, or specialists. For hepatitis B, we have oral medications that suppress the virus and keep it at bay. Then we do serial blood tests and ultrasounds to monitor and slow the progression of the disease, to prevent liver failure, and to detect liver cancers early. We are very interested in testing asymptomatic people for hepatitis C, because if we cure all who have it, we can eradicate the disease like we eradicated smallpox. That’s really what pushes us toward early diagnosis and aggressive treatment.”
Because ID care has been in the community for such a long time, its specialists are well known among the people they treat. Often friends or family will refer patients to ID Care, but many referrals come from other physicians.
Typically, treatment takes place on an outpatient basis in the ten ID Care practice locations throughout New Jersey. “It’s a complicated process to sort out the different genotypes for hepatitis C,” said Dr. Aslam, “so we run a lot of blood tests before we administer the medicines. The whole system is in place and ready to go at our facility.”
Treating Hepatitis A, B, C: ID Care Infectious Disease Doctors
According to Dr. Aslam, “ID Care’s unique experience treating chronic illnesses like HIV is what sets us apart. We identify the risk factors, diagnose the strains, and do a lot of community teaching where our patients live. Some of the hepatitis patients we’re trying to help are IV drug users. Because of our experience treating people with HIV, we have a lot of community and healthcare connections, and we can help patients get into detox and recovery programs to break habits that raise the risk for hepatitis B and C.”
Sometimes, the complex antiviral medicines used for hepatitis B and C can interact with other drugs, and some patients are resistant to their effects. Interestingly, some people who have hepatitis B or C along with HIV may be prescribed hepatitis medications that can affect their HIV as well. “If you have both the diseases, a combination treatment is best, otherwise, patients can develop resistance,” warned Dr. Aslam, adding that “close monitoring is key in these cases.”
Difficult, multi-disease scenarios do happen, and according to Dr. Aslam, “ID Care is better trained, equipped, and experienced to detect and address the complications, drug interactions, and side issues like drug dependence, depression, and substance abuse that can interfere with successful treatment. We provide a uniquely high level of care to our patients with viral hepatitis and related problems.”
As New Jersey’s largest infectious disease practice, ID Care is a leader in the prevention and treatment all infectious diseases like hepatitis A, B, and C as well as other serious infections. To learn more, call 908-281-0221 or visit idcare.com to schedule an appointment today with an ID Care infectious disease expert.
