Your liver, which is about the size of a football and located in the right upper part of your abdomen, works hard. It filters toxins, helps digestion, processes nutrients and produces proteins that fight infections.
Hepatitis can keep your liver from doing its job. This inflammation or irritation of the liver can be caused by autoimmune disorders, excessive alcohol use or other liver diseases. It’s also caused by viruses; in the United States, we are most familiar with hepatitis A, B and C. Left untreated, some of these viral hepatitis infections can lead to chronic disease, liver failure and the need for a liver transplant.
There is good news about viral hepatitis, though: Two of these viral infections can be prevented by vaccines, and doctors have medications to treat and cure many cases of hepatitis.
We talked to UNC Health hepatologist Michael Fried, MD, to learn more.
Hepatitis A
Hepatitis A is transmitted via a fecal/oral route—that means if a person who has the virus uses the bathroom, gets feces (poop) on their hands, doesn’t wash them and then touches a plate of food, the person eating the food could become infected. That’s why you’ll often hear about hepatitis A outbreaks at restaurants. It also can be spread through sexual contact and by sharing needles.
Symptoms start to appear two to six weeks after infection.
“Hepatitis A in the United States is usually highly symptomatic, and during the acute phase, you’ll feel really terrible for several weeks,” Dr. Fried says.
Symptoms include diarrhea, nausea and vomiting, fatigue, fever and jaundice, or yellow eyes.
There is no treatment for hepatitis A. You’ll want to stay hydrated and rest while your immune system fights the infection. Symptoms typically take about six weeks to fully resolve.
“I want to stress that hepatitis A can be avoided and prevented with a vaccine,” Dr. Fried says. “It’s a very safe vaccine, given in two doses, and recommended as part of routine child vaccination.”
It’s important to check your vaccine status before traveling abroad; in other parts of the world, especially countries with limited access to clean water, hepatitis A is more common than it is in the U.S.
Unlike other forms of hepatitis, this virus does not cause chronic, or long-term, disease.
Hepatitis B
Like hepatitis A, hepatitis B can be effectively prevented by vaccination. This virus is spread through bodily fluids including blood and semen, commonly during sex with an infected person or sharing of needles. It’s not spread through living with someone with the virus and can’t be transmitted through touch.
It can be spread from mother to infant during childbirth, which Dr. Fried says is more common in some Asian and West African countries.
“If you acquire hepatitis B as a child from your mother, it tends to become chronic, so there’s a cycle of chronic and endemic disease in other countries,” Dr. Fried says. “In the U.S., if you acquire it as an adult, the opposite is true—only about 5 percent of cases become chronic.”
Hepatitis B causes the same symptoms as A, and most people recover on their own in six weeks. However, this form of hepatitis doesn’t always cause symptoms, especially in its chronic form, which means you may not know if you were infected. About 850,000 people in the U.S. are estimated to be living with hepatitis B, but 67 percent of them don’t know they have it.
“All adults should be tested for hepatitis B at least once,” Dr. Fried says. “If you’ve been vaccinated, you don’t require more testing. People with other risk factors, such as multiple sexual partners or injecting drug use, should get additional testing.”
Hepatitis B is typically tested for during pregnancy, to prevent mother-to-child transmission.
If untreated, chronic hepatitis B can cause fibrosis, or scarring of the liver, which can advance to cirrhosis, advanced scarring. Cirrhosis can lead to liver failure and require liver transplant.
“There is no cure for hepatitis B, but there are great treatments that suppress the virus,” Dr. Fried says. “The disease can be controlled to prevent those long-term complications.”
Researchers are working on treatments that might provide a cure in coming years.
Hepatitis C
There is no vaccine to prevent hepatitis C. It is spread by blood, so the most common way to be exposed to the virus is through sharing needles during drug use. It can be transmitted mother-to-child, but it’s rare to transmit it sexually. Prior to the discovery of the hepatitis C virus in 1989, people acquired the disease through blood transfusions, but blood is now screened for the virus.
The problem is that while hepatitis C can cause the same symptoms of fatigue and nausea, it usually doesn’t cause any symptoms. Like hepatitis B, that means you may not know you have the virus. Unlike hepatitis B, hepatitis C carries a much higher risk of chronic disease and long-term complications.
“If you contract B as an adult, it’s chronic about 5 percent of the time, but with hepatitis C, it can become chronic 50 to 70 percent of the time,” Dr. Fried says. “Because chronic infection doesn’t have any symptoms at first, you might only get a diagnosis when you’re being tested for another reason.”
Health officials estimate that between 2.4 million and 4.7 million people in the U.S. have hepatitis C, and that half are unaware of the infection. The U.S. Preventive Services Task Force recommends that all adults aged 18 to 79 are screened for the hepatitis C virus at least once; injecting drug users should be screened more often.
“The good news is that once this is diagnosed, it can be completely cured,” Dr. Fried says. “We have remarkable treatments that most people can tolerate with very few side effects.”
Dr. Fried says the current treatments, which are pills taken for 8 to 12 weeks, are a huge advance from early treatments, which were injections with many side effects and a low cure rate.
“I still see patients who were scared off by early treatments, which were burdensome and had a lot of side effects,” he says. “We used to have to risk/benefit assessments of who would benefit from those treatments, but now the medications are very effective and safe, so there’s no reason not to treat.”
Your ability to get treatment depends on knowing you’re infected, though.
“The key is appropriate screening, because a lot of people are still not aware of their infection because they don’t have symptoms,” Dr. Fried says. “Talk with your primary care provider about testing so this can be identified and treated before it leads to advanced liver disease.”
If you’re concerned about your risk for hepatitis, talk to your doctor. If you need a doctor, find one near you.