Hepatitis is a serious inflammation of the liver. Viral hepatitis, the most common form, usually appears as type A, B, or C. Type B (HBV) and Type C (HCV) affect people of all ages. Hepatitis can result from long-term alcohol abuse, infection, or exposure to various chemicals and drugs.
The different types of hepatitis
have many similarities and are therefore discussed here as a whole. If you know that you are infected only with a particular form, you can safely skip to the appropriate sections below.How does HBV spread?
The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected. This can occur through having sex with an HBV-infected person without using a condom (the effectiveness of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce spread of HBV).
Sexual contact is the most common reason for the spread of HBV infection in the United States. The spread of HBV from male to female or female to male accounts for about 1 out of 3 acute (recently acquired) HBV infections in adults. The risk of spreading HBV increases if the male or female has multiple sex partners, a history of a sexually transmitted disease, or has sex with an HBV-infected person. About 1 out of 4 acute HBV infections occur among men who have sex with men.
HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. The risk of HBV infection from HBV-contaminated needlesticks is much greater than the risk of spreading HIV
by this method. In the United States, illegal drug use injection accounts for about 16% of acute HBV infections. Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of HBV when good infection control practices have not been used. Unsafe injections in medical settings are a major source of HBV spread in many developing countries and might be a risk for United States residents traveling abroad, if medical care is required in settings that have poor infection control practices.
HBV is also spread through needlesticks or sharps exposures on the job and from an infected mother to her baby during birth. Breastfeeding has not been associated with the spread of HBV.
HBV can also be spread during childhood. Most early childhood spread occurs in households of people with chronic (life-long) HBV infection, but the spread of HBV has also been seen in daycare centers and schools. The most likely way that the spread of HBV occurs during early childhood involves contact between an infected person's body fluids (e.g., their blood or drainage from their wounds or skin lesions
) and breaks in the child's skin. HBV can be spread also when an HBV-infected person bites another person who is not infected. HBV can be spread also by an infected person pre-chewing food for babies, and through contact with HBV from sharing personal-care items, such as razors or toothbrushes. The virus remains infectious and capable of spreading infection for at least seven days outside the body. Virus can be found on objects, even in the absence of visible blood.
HBV is not spread through food or water, sharing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting. People with chronic HBV infection should not be excluded from work, school, play, childcare, or other settings.How long can a person with HBV infection spread HBV?
A person with acute or chronic HBV infection is contagious as long as they have the virus in their blood, which can only be determined by blood testing. In general, a person with acute hepatitis B
gets rid of the virus in their blood in six months. If this does not happen, it is likely the person will become chronically infected with HBV for life.
Incidence; Causes and Development; Contributing Risk Factors
Infectious (viral) hepatitis
type A (HAV), is the most common hepatitis, often affecting school children. Unlike the other hepatitis types which are seen in all ages equally, hepatitis A
in seen mostly in children and young adults.
We are in the midst of an epidemic of Hepatitis B
and C infections. Between 1% and 5% of the world's population is infected chronically with one or more of these two viruses. In some parts of the world, such as Egypt and the Far East, up to 15% of the normal population suffer from infections with these viruses. The CDC estimates that 4 million Americans are infected with the hepatitis
- Hepatitis A: Epidemics are frequent, as the virus is spread easily through food that is handled by infected individuals, and through water.
- Hepatitis B: Hepatitis B (HBV) is usually transmitted by injection of contaminated blood, through intravenous (IV) drug use, or through sexual activity. HBV can be transmitted during pregnancy or childbirth.
- Hepatitis C: Hepatitis C (HCV) is spread via blood, most commonly through shared needle use, and may lead to a chronic carrier state. Carriers of hepatitis B and C often do not know that they are infected. HCV infections and other chronic viral infections are associated with a variety of immune system defects leading to effective transmission of the viruses through blood exposure and possibly sexual contact. HCV can be transmitted during pregnancy or childbirth.
The following are risk factors for Hepatitis B
, which your doctor should be told about:
- Working in health care, such as in a medical laboratory or in dialysis
- Engaging in unsafe/promiscuous unprotected sex
- Injecting drugs
- Having a poor selenium status
- Having a parent, sibling or child infected with hepatitis
- Living in or being exposed to unsanitary conditions
- Consuming possibly contaminated food or water
- Eating or handling raw shellfish
Receiving a tattoo can also increase your risk of contracting Hepatitis B or C.
Signs and SymptomsHepatitis A
is contagious during the incubation period of 2-6 weeks but only for a few days once symptoms appear.
Diagnosis and Tests
is suspected, your health care provider will feel and tap your chest and back to determine if your liver
is enlarged or tender. Your provider will request a blood test, possibly a urine test and, in a few cases, a liver biopsy
The following blood tests are available:
- Hepatitis B surface antigen (HBsAg) A positive test means that you have hepatitis B virus in your blood and can pass the virus to others. You could be recently infected or you could have chronic (life-long) infection. A negative test means that you do not have the virus in your blood.
- Antibody to hepatitis B surface antigen (anti-HBs) A positive test means that you are immune (cannot get hepatitis B). This positive test occurs when you were either vaccinated with hepatitis B vaccine successfully or you had the actual infection. Either way, this immunity means you will not get hepatitis B again.
- Antibody to hepatitis B core antigen (total anti-HBc) A positive test means you currently have or have had infection with hepatitis B virus at some undefined time period. The positive test has no relationship to having received hepatitis B vaccine; however, the test might be used prior to vaccination to see if you had already been infected.
- IgM antibody subclass of anti-HBc (IgM anti-HBc) A positive test means that you were recently (within 6 months) infected with hepatitis B virus.
- Hepatitis B "e" antigen (HBeAg) If this test is positive, you are infected with hepatitis B virus and have a large amount of hepatitis B virus in your blood. You are at increased risk of serious liver problems due to your chronic hepatitis B virus infection.
- Antibody to hepatitis B "e" antigen (Anti-HBe) This blood test might be positive if you have chronic hepatitis B virus infection or if you have already recovered from your infection. If have chronic hepatitis B virus infection and this test is positive, this means that you have low levels of hepatitis B virus circulating in your blood and are at lower risk of liver problems due to your chronic hepatitis B virus infection.
- HBV Deoxyribonucleic acid (HBV-DNA) When this test is positive, it means you are infectious to others and the hepatitis B virus is active in your body, possibly causing liver damage. The test is often used to determine success or failure of drug therapy if given for chronic hepatitis B virus infection.
Treatment and Prevention
is potentially very dangerous, a healthcare professional should be involved in its treatment.
- Hepatitis A: Good hygiene is necessary to avoid spreading the infection. People with hepatitis A should wash their hands very carefully after using the restroom and should not handle food at work.
While there is no specific treatment for HAV (most of the treatments mentioned here are for the other types), supportive care is helpful while you fight the infection. Alcohol should be avoided. Coconut milk, not water, is antiviral and said to help in any hepatitis. Bed rest, lots of water, liver supportive herbs such as milk thistle or dandelion would be appropriate.
- Hepatitis B: Numerous nutritional and herbal treatments are available. Items not mentioned elsewhere include:
- Desiccated liver – can improve liver regeneration.
- Hepatitis Specific Transfer Factors from colostrum were used in 260 cases and a 100% clinical recovery was reported with no side-effects. Immunological profiles were normalized in approximately half of the individuals at the end of the observation period.
- Hepatitis C: Examination of liver tissue under the microscope taken from patients with chronic active HCV infection has revealed the presence of NK cells. Indirect evidence for the importance of high NK cell function in limiting chronic hepatitis C infection was demonstrated by two studies of infected patients treated with alpha interferon. Patients that responded clinically to therapy also demonstrated significantly greater enhancement of NK activity than controls after the initial dose of interferon. NK activity was not improved in those who did not respond to treatment, indicating the importance of NK activity.
There are only limited conventional treatments for HCV: it is a disease that can be greatly benefited by natural therapies. Since the persistence of a virus is due in part to lowered immunity, non-toxic immune enhancers (especially those which stimulate NK cell function) should help to resolve or control the infection.
Several nutrients and herbs have been shown to inhibit viral reproduction, improve immune system function, and greatly stimulate regeneration of the damaged liver cells. A therapeutic approach should focus on both immune system enhancement and liver support.
Unlike other white blood cells, inadequate numbers of NK cells are rarely a problem. Instead, it is the activity of the cells that is important. NK activity can be significantly enhanced by natural products or drugs such as IP6 (Inositol hexaphosphate), MGN3 (a commercial rice bran product modified with mushroom extracts), thymus extracts, low dose Naltrexone, zinc, DHEA, glutamine, a good multiple vitamin-mineral over time and others such as astragalus, cordyceps (chinese fungus), and MCP (modified citrus pectin). NK activity can be impaired by surgery and chemotherapy. Moderate exercise does not depress the immune system, but very strenuous exercise does.
Other treatments that have been beneficial include the use of Vitamin C, liver extracts (which promote hepatic regeneration) and Reishi mushrooms. Licorice root, cysteine and glycine together have produced a 40% cure rate. Silymarin (milk thistle) reverses liver cell damage, increases protein level in the blood, lowers liver enzymes and generally improves symptoms such as abdominal discomfort, decreased appetite and fatigue.
- Cover all cuts and open sores with a bandage.
- Discard used items such as bandages and menstrual pads carefully so no one is accidentally exposed to your blood.
- Wash hands well after touching your blood or infectious body fluids.
- Clean up blood spills; then clean the area again with a bleach solution (one part household chlorine bleach to 10 parts of water).
- Tell your sex partner(s) you have hepatitis B so they can be tested and vaccinated (if not already infected or vaccinated). Partners should have their blood tested 1-2 months after three doses of vaccine are completed to be sure the vaccine worked.
- Use condoms (rubbers) during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test (as described above) demonstrating immunity to HBV infection. (Condoms might also protect you from other sexually transmitted diseases).
- Tell household members to see their doctors for testing and vaccination for hepatitis B.
- Tell your doctors that you are chronically infected with HBV.
- See your doctor every 6-12 months to check your liver for abnormalities, including cancer.
- If you are pregnant, tell your doctor that you have HBV infection. It is critical that your baby is started on hepatitis B shots within a few hours of birth.
- Don't share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that might have come in contact with your blood or infectious body fluids.
- Don't pre-chew food for babies.
- Don't share syringes and needles.
- Don't donate blood, plasma, body organs, tissue, or sperm.
- Hepatitis A: It typically lasts for 4-8 weeks. Immunity is life-long following infection. HAV does not become chronic like hepatitis B and C can, does not create a carrier state, and does not lead to chronic liver disease. Often, the disease may be so mild it is unrecognized. The vast majority (99%) of people infected with HAV get rid of the infection on their own, and fatalities are rare.
- Hepatitis B: Following an acute infection caused by hepatitis B virus, fewer than 1% of patients develop fulminant hepatitis and die. Some 85-90% experience complete resolution of their physical findings and develop protective levels of antibody; the other 10 to 15% of patients become chronically infected. Of these, 15 to 30% subsequently develop chronic active or persistent hepatitis or cirrhosis, and about 20% of those with cirrhosis will develop liver cancer.
- Hepatitis C: Hepatitis C is a serious infection. If you do not make continued efforts at maintaining a significant level of liver health, a chronic degenerative process will take its toll eventually. Although the disease may be moderate in expression, a carrier state can follow in 10-50% of patients. Infection with Hepatitis B or C often leads to liver failure or liver cancer and is the leading indication for liver transplantation.
HBV is a known risk factor for primary liver