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What is viral hepatitis?
Hepatitis is an inflammation of the liver. Viral hepatitis is a disease of the liver caused by one of several viruses: hepatitis A, B, C, D or E. Hepatitis D and E are very rare, so we will not discuss them here.
The hepatitis A, B and C viruses cause short-term (acute) viral hepatitis, but the hepatitis B and C viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes for life.
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What causes viral hepatitis?
Viral hepatitis is caused by the hepatitis A, B or C viruses. Hepatitis A can be transmitted by contaminated food or water. Hepatitis B and C occur when blood or bodily fluids from an infected person enter the body of an un-infected person. These viruses can be transmitted through various means, such as illicit intravenous drug use, unprotected sex, or from a mother to her newborn during birth. Blood transfusions, especially those received before 1990, used to be a source of hepatitis B and C, but blood used in transfusions is now screened for the hepatitis viruses.
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What are the differences between hepatitis A, B and C?
Hepatitis A virus (HAV) is transmitted when contaminated food or liquid is ingested. Raw food, undercooked food, food handled by people who have not washed their hands and water contaminated by animal or human waste are usually the sources of this virus. HAV can be prevented with a number of vaccines, but there are no antibiotics to treat it once you have it. However, people usually recover from symptoms on their own in about 4 to 6 weeks.
Hepatitis B virus (HBV) is the most common strain of hepatitis in the world. People infected with HBV or who are carriers can spread the virus through sexual contact, blood and other body fluids. Many people with HBV recover completely and develop lifelong immunity to the virus. However, sometimes HBV can cause chronic or life-long hepatitis, which can lead to scarring of the liver (cirrhosis) and liver cancer. Also, 90% of babies born to mothers with HBV have a high probability of developing chronic HBV when they are older. HBV can be treated with various drugs and there is a vaccine to protect against it.
Hepatitis C virus (HCV) can be transmitted through unsterilized needles used in tattooing and body piercing. It has also been associated with illicit intravenous drug use. In Canada, an estimated 210,000 to 275,000 people are currently infected with HCV. Up to 90% of HCV-infected people carry the virus indefinitely, and over the long term, these people may be at risk for scarring of the liver (cirrhosis) and liver cancer. There are drugs to treat people infected with HCV, but there is currently no vaccine to protect against it.
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Who is more likely to get hepatitis B?
People who do not practice safe sex are more likely to get the hepatitis B virus (HBV). HBV is the most common strain of hepatitis, and it is transmitted through blood and other bodily fluids. It can also be passed from an infected mother to her newborn.
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What are the signs and symptoms of the hepatitis B?
About 30% of people infected with the hepatitis B virus have no signs or symptoms; signs and symptoms are more common in adults than in children. When signs and symptoms appear they include: jaundice (yellowing of the skin and eyes), fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain.
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How is hepatitis B diagnosed?
The hepatitis B virus (HBV) diagnosis is done through blood tests. A completely negative result means that you have never been exposed to, nor immunized against, HBV. In this case, you can benefit from immunization.
A positive antibody test (anti-HBs) means that you have been infected with HBV in the past and have recovered completely, or that you have been successfully immunized against HBV. (An antibody is a protein produced by the body's immune system that helps fight infections.)
A positive antigen test (HBsAg) means that you are carrying HBV; it can be an acute (short-lasting) or chronic (long-lasting) infection. If the virus continues to show up in your blood after 6 months, you have a chronic infection and are a carrier of the hepatitis B virus. (An antigen is a bacteria, virus, or other substances foreign to the body.)
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What is the goal of treatment for hepatitis B
The treatment goal for the hepatitis B virus is to render the infection inactive and help control disease progression.
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What are the treatment choices for hepatitis B?
There are two types of treatments available to help treat the hepatitis B virus (HBV): injectable interferon-alpha and oral direct inhibitors of the virus, like lamivudine, adefovir, entecavir and telbivudine.
Interferon-alpha and pegylated interferon-alpha are part of a class of drugs called “interferons” which are used for relatively short periods of time. Interferon works by enhancing the body’s immune activity against the hepatitis B virus and is only effective once the immune system has become activated against the HBV. Interferon-alpha is administered by injection either once daily, three times per week, or once per week for four to six months, but some patients may need up to two years of therapy. Interferon is effective in rendering the HBV infection inactive in approximately one third of treated patients. However, side effects may be problematic for some.
Lamivudine, adefovir, entecavir, and telbivudine are oral antiviral agents that work directly against the hepatitis B virus by helping to suppress virus replication. These therapies are part of a class of drugs called “nucleoside/nucleotide analogues”. They may be used for either short or long periods of time. However, therapy may be required for years and in some cases indefinitely. These drugs are taken by mouth once a day and are generally well tolerated.
It is recommended not to drink alcohol, as it can worsen liver disease.
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How can I help make sure I don't give hepatitis B to others?
If you have been diagnosed with hepatitis B there are some precautions you should take to avoid spreading the virus:
- Practice safe sex by using condoms and encourage your sex partner(s) and all people you live with to get tested for hepatitis B. If they have not already been infected, they should be vaccinated against hepatitis B.
- If you are pregnant or planning to have children, there is a high risk of passing the virus on to your baby. However, the baby can be protected through immunization. At birth, your baby will receive hepatitis B immune globulin (HBIG) and the first dose of the hepatitis B vaccine. The second dose is given when the baby is one month old; the third (and last) dose is given at six months old. This gives your baby a 95% chance of not being infected with hepatitis B. Although hepatitis B screening is part of the prenatal testing in some provinces, be sure to discuss this matter with your family doctor or obstetrician.
- Tell your doctor, dentist and other healthcare providers so that they can take necessary precautions.
- Never share your toothbrush, razor, nail file or other personal items that might contain traces of blood.
- If you are considering getting a tattoo or body piercing, make sure the artist or piercer follows proper health practices.
- Never donate blood or semen.
- Get rid of articles contaminated with your blood (tampons, dental floss, bandages, needles, broken glass) by placing them in a protective container.
- Cover all cuts and sores with bandages. Avoid swimming in public pools if you have open cuts and sores.
- Clean up spills of your blood with freshly diluted household bleach (one part bleach, nine parts water) and let it stand for 10 minutes before wiping it away. The bleach will kill any hepatitis B virus left on the surface.
- Refrain from preparing food if you have bleeding cuts or sores on your hands.
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Who is more likely to get hepatitis C?
Hepatitis C virus (HCV) primarily affects injection-drug users who share needles, non-sterile instruments, and other drug equipment. Approximately two-thirds of new HCV infections each year are related to injectable drug use; cleaning the equipment with bleach does not always completely kill the virus.
Another way of getting HCV is through a blood transfusion from an infected donor, especially for people who received a transfusion before 1990. The risk of getting HCV this way is extremely low now because all blood donors go through universal blood testing. Other ways of transmission are through tattooing and body piercing done with infected needles. Since HCV is carried in the blood, sharing items such as toothbrushes and razors with an infected person can also spread the virus.
There is a 5% risk of a mother passing the hepatitis C virus to her newborn.
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What are the signs and symptoms of hepatitis C?
About 80% of people infected with the hepatitis C virus have no signs or symptoms. When signs and symptoms appear they include: jaundice (yellowing of the skin and eyes), fatigue, dark-coloured urine, abdominal pain, loss of appetite and nausea.
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How is hepatitis C diagnosed?
Most people infected with the hepatitis C virus (HCV) do not know they have it and carry it for many years. Only a blood test can detect HCV, so if you think you may have been exposed to HCV through high-risk behavior, major surgery or a blood transfusion, you should see your doctor and discuss whether or not you should be tested.
If you test positive for antibodies to HCV, your doctor will do a follow-up blood test to find out whether actual viral substances are present in your blood. He will also do some blood tests to check the condition of your liver.
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What is the goal of treatment for hepatitis C?
The goal of treatment for people diagnosed with new hepatitis C virus (HCV) infections is to get rid of the virus or to suppress virus replication in order to avoid permanent liver damage. Many people with chronic hepatitis C will feel well for years. But in 10%-20% of people, chronic HCV may lead to irreversible and potentially fatal scarring of the liver. This is called cirrhosis. In severe cases HCV may lead to liver cancer or liver failure and a liver transplant may be necessary. So the earlier you find out you have HCV, the more likely it is that treatment will be successful.
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What are the treatment choices for hepatitis C?
About 15-25% of people infected with the hepatitis C virus (HCV) have a mild case of the disease and get rid of it on their own in a brief amount of time. When this happens, the HCV antibodies remain detectable in the blood but the actual virus does not. Unfortunately, most people who become infected with HCV will have the infection for a long time and possibly for the rest of their lives. If this is the case, your doctor may refer you to a specialist to decide whether or not you need treatment. Drug treatment is usually a combination of two antivirus drugs: pegylated interferon and ribavirin. Pegylated interferon (a drug used to help fight infection) is given by injection and is a long acting interferon. Ribavirin is an antivirus drug and is taken as an inhaled solution or pill. This combination can get rid of the virus in about half of treated patients. It is recommended not to drink alcohol, as it can worsen liver disease.
In severe cases, chronic, long-term HCV may lead to liver cancer or liver failure and a liver transplant may be needed.
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How can I help make sure I don't give hepatitis C to others?
If you have been diagnosed with hepatitis C there are some precautions you should take to avoid spreading the virus:
- Do not give blood.
- Never share your toothbrush, razor, nail file or other personal items that might contain traces of blood.
- If you are considering getting a tattoo or body piercing, make sure the artist or piercer follows proper health practices.
- Do not use illicit intravenous drugs; if you do, don’t share needles or other drug-related equipment.
- Tell your doctor, dentist and other healthcare providers so that they can take necessary precautions.
- Although sexual transmission is rare, inform your partner(s) and take appropriate precautions.
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If I think I have hepatitis, do I have to treat it?
The best way to protect yourself from getting hepatitis A or B is to get vaccinated.
There is no treatment for Hepatitis A; if you contracted it, you will recover from it on your own in a few weeks.
If you have already been diagnosed with hepatitis B (HBV) you may recover on your own and develop an immunity (protective antibodies) against future HBV infections. However, a small number (5-10%) of people will not be able to get rid of the virus and will go on to develop chronic HBV. In this case you should be monitored regularly since you may be at increased risk of developing liver damage such as cirrhosis (scarring) or liver cancer (hepatocellular carcinoma). Your physician will decide if and when you should be put on treatment, depending on factors such as age or stage of disease. You should see your doctor every six months. The visits may include a physical exam, blood tests for hepatitis B markers and for liver function, and liver ultrasound (imaging).
If you have already been diagnosed with hepatitis C (HCV) your physician should do follow-up blood tests to check the state of your liver. About 15-25% of HCV-infected people have only a mild, brief infection and, as with HBV, recover on their own and develop an immunity (protective antibodies) against future HCV infections. Unfortunately though, unlike HBV, most people who contract HCV will be infected for a long period of time and possibly for the rest of their lives. In this case your doctor may refer you to a specialist to decide whether or not you require treatment. In 10-20% of people, chronic HCV leads to cirrhosis and, in severe cases, can lead to liver cancer or liver failure. Hepatitis C is one of the most common reasons for liver transplants in Canada.
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Are there vaccines to protect against hepatitis B and C?
There is a hepatitis B vaccine, and it has been available since 1982. Routine vaccinations are available for newborns through age 15. Vaccinations are also an option for people of all ages in high risk groups.
Unfortunately, there is no hepatitis C vaccine at this time.
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What questions might I ask my healthcare provider about treating hepatitis?
If you or a loved one has been diagnosed with viral hepatitis, you may find it helpful to write down any questions you want to discuss with your healthcare provider before your next appointment. Here are a few suggestions to help you get started on your own list:
- What kind of hepatitis do I have?
- Will my hepatitis resolve on its own?
- What are my treatment choices?
- How effective will the treatment be?
- Are there any serious complications I should know about?
- How can I help make sure I don't give hepatitis to others?
- Should those close to me get vaccinated against hepatitis?
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