Most people have heard of hepatitis, but many don’t know it’s actually five different types of viruses — A, B, C, D, and E — that spread differently and pose unique health risks. These widely misunderstood viruses affect millions worldwide through contaminated food, blood exposure, and intimate contact. Learn the ABCs of hepatitis to help protect you and your community.
What is hepatitis?
Hepatitis is an inflammation of the liver, a vital organ that cleans blood, processes food and medicines, and helps remove waste from the body.
“The liver has many important functions,” said Victor Machicao, MD, an associate professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition at McGovern Medical School at UTHealth Houston. “Whatever we eat and digest is usually absorbed by the small intestine, and all that blood with nutrients goes through the liver.”
While many people associate hepatitis with viral infections, Machicao said that alcohol consumption, medications, or even autoimmune conditions can also cause hepatitis.
No matter the type of hepatitis virus, symptoms from one to another are generally the same: fever, nausea and vomiting, pain in the abdomen, yellowing of the eyes or skin (jaundice), and generalized fatigue. Many people don’t experience symptoms in the beginning, or ever.
Hepatitis A: Foodborne
Hepatitis A spreads mainly by eating food that has been contaminated with an infected person’s stool. It causes an acute infection that generally resolves on its own after a few weeks. This type of hepatitis can trigger outbreaks at food establishments due to poor employee hygiene.
“Most adults with a normal immune system will be able to recover from the acute infection without having any consequences in the long run from the virus,” Machicao said.
Hepatitis A is easily preventable with vaccination. Machicao said pediatricians are recommending vaccinating all children, which was not the case 20-30 years ago.
Hepatitis B: Blood-borne (chronic)
Hepatitis B is primarily transmitted through blood contact. The Hepatitis B Foundation considers hepatitis B a “silent infection.” People can be infected for years without knowing they have the virus, and unknowingly spread it to others. This can include sharing contaminated needles among IV drug users, blood transfusions, and, in rare instances, from contaminated instruments during surgical or dental procedures. It also could be as simple as sharing a toothbrush or razor with an infected person.
Transmission is possible through unprotected sex and from an infected mother to her baby during birth. It can most likely become a chronic condition if acquired at a young age.
Acute versus chronic infection
- About 95% of adults who acquire hepatitis B will develop immunity and eliminate the chance of future infection.
- Around 90% of children who acquire it will develop chronic hepatitis B.
“Most patients with chronic hepatitis B live a normal life for the first 30-40 years,” said Machicao. “Hepatitis B starts causing problems as you get older and can eventually damage the liver, causing cirrhosis and liver cancer.”
If hepatitis B is caught before it causes cirrhosis, where scar tissue replaces healthy liver tissue, antiviral medications can suppress the virus and prevent the progression to cirrhosis. Antiviral treatment allows people with hepatitis B to live long lives.
Hepatitis C: Blood-borne (curable)
Hepatitis C spreads through contact with an infected person’s blood. Unlike hepatitis B, this type has minimal sexual transmission. IV drug use is a significant risk factor. Other risky behaviors include inhaling cocaine and getting tattoos with unsterilized needles and other contaminated equipment.
“We have made tremendous progress curing hepatitis C with direct oral antivirals now,” Machicao said. “We can treat almost everyone with hepatitis C, whether it’s acute or chronic. I don’t have a single patient in the last five years where I could not get rid of the hepatitis C, as long as they take the treatment.”
Treatment typically lasts three to six months and has a 95% cure rate. Once cured, it doesn’t come back unless risky behaviors resume.
Additional viruses: D and E
The alphabet soup of hepatitis continues with hepatitis D (or hepatitis delta), although there aren’t many cases in the United States. A person must have hepatitis B to acquire the hepatitis D virus, which makes the infection more aggressive.
Hepatitis E is quite similar to hepatitis A, with oral-fecal transmission. Machicao said hepatitis E is not uncommon in Texas, and particularly in Houston, because of the many people traveling back and forth to Mexico, where hepatitis E is prevalent.
Prevention, diagnosis, and treatment challenges
Vaccines are available for hepatitis A and B. All pregnant women are screened for hepatitis B to prevent transmission to newborns. There is no vaccine for hepatitis C.
Blood tests can identify specific viral hepatitis types. Machicao said that, locally, most physicians test for A, B, and C. Simple liver function tests can indicate potential liver problems. Machicao recommends regular screenings for at-risk individuals.
The most challenging aspect regarding hepatitis is the stigma associated with it. Misconceptions about treatment availability and effectiveness are other challenges.
“The critical aspect in the liver field is we haven’t been able to come up with a good machine or device that can replace the liver,” Machicao said. “People with kidney failure can do dialysis, and those with a bad heart can get a heart pump, which can deliver blood to all your organs.”
Talk to your health care provider to keep your liver health in check. Early diagnosis can help contribute to the best outcomes.
