Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents, leading to a range of health problems, some of which can be fatal.
There are five main strains of the hepatitis virus, referred to as types A, B, C, D, and E. While they all cause liver disease, they differ in important ways, including modes of transmission, severity of the illness, geographical distribution, and prevention methods.
Types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis, liver cancer, and viral hepatitis-related deaths. An estimated 354 million people worldwide live with hepatitis B or C, and for most, testing and treatment remain beyond reach.
Hepatitis A
Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person.
The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene, and oral-anal sex. Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease, but it can cause debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal.
Symptoms
Symptoms of hepatitis A range from mild to severe and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the eyes and skin). Not everyone who is infected will have all the symptoms
Prevention
Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A. The spread can be reduced by:
- adequate supplies of safe drinking water;
- proper disposal of sewage within communities; and
- personal hygiene practices such as regular handwashing before meals and after going to the bathroom.
Hepatitis B
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For most people, hepatitis B is short-term, also called acute, and lasts less than six months. But for others, the infection becomes chronic, meaning it lasts more than six months.
Having chronic hepatitis B increases your risk of developing liver failure, liver cancer, or cirrhosis, a condition that permanently scars the liver.
Most adults with hepatitis B recover fully, even if their symptoms are severe. Infants and children are more likely to develop a long-lasting hepatitis B infection. This is known as a chronic infection.
A vaccine can prevent hepatitis B, but there’s no cure if you have the condition. If you’re infected, taking certain precautions can help prevent spreading the virus to others.
Symptoms
The symptoms of acute hepatitis B range from mild to severe. They usually appear about 1 to 4 months after you’ve been infected, although you could see them as early as two weeks after you’re infected. Some people, usually young children, may not have any symptoms.
Hepatitis B signs and symptoms may include:
- Abdominal pain
- Dark urine
- Fever
- Joint pain
- Loss of appetite
- Nausea and vomiting
- Weakness and fatigue
- Yellowing of the skin and the whites of the eyes, also called jaundice
Treatment
There is no specific treatment for acute hepatitis B. Chronic hepatitis B can be treated with medicines.
Care for acute hepatitis B should focus on making the person comfortable. They should eat a healthy diet and drink plenty of liquids to prevent dehydration from vomiting and diarrhoea.
Chronic hepatitis B infection can be treated with oral medicines, including tenofovir or entecavir.
Treatment can:
- slow the advance of cirrhosis
- reduce cases of liver cancer
- improve long-term survival.
Most people who start hepatitis B treatment must continue it for life.
With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria.
In low-income settings, most people with liver cancer present late in the course of the disease and die within months of diagnosis.
In high-income countries, patients present to the hospital earlier in the course of the disease and have access to surgery and chemotherapy, which can prolong their lives for several months to a few years.
Liver transplantation is sometimes used for people with cirrhosis or liver cancer in technologically advanced countries, with varying success.
Prevention
Hepatitis B is preventable with a vaccine.