What is Hepatitis and How to Prevent and Treat an Infection?

What Is Hepatitis?  

Hepatitis is inflammation of the liver, which can negatively affect liver function. It can be either viral or non-viral. Non-viral causes of hepatitis include autoimmune diseases, alcohol-induced damage, and toxins from chemicals or high doses of certain medications.

There are five main strains of the hepatitis virus: types A, B, C, D, and E. While they all cause liver disease, they differ in important ways, including modes of transmission, severity of illness, geographical distribution, and prevention methods.

Viral hepatitis can be classified as either an acute infection, which is short-term, or a chronic infection, which lasts for a long time. For instance, hepatitis A and E are associated with acute infections, while hepatitis B, C, and D can lead to both acute and chronic liver infections.

Prevalence of Hepatitis   

According to the World Health Organization (WHO), an estimated 300 to 325 million people worldwide live with hepatitis B or C, and for most, testing and treatment remain beyond reach. In particular, hepatitis type B leads to chronic disease in millions of people and is the most common cause of liver cirrhosis, malignancies, and viral hepatitis-related deaths. 

It is possible to prevent hepatitis. Some types of hepatitis can be easily prevented through vaccination, and others through access to clean food and water. A World Health Organization (WHO) study found that an estimated 4.5 million premature deaths could be prevented in low-and middle-income countries by 2030 through vaccination, diagnostic tests, medicines, and education campaigns. The WHO’s global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% between 2016 and 2030.

While the estimated number of new conditions has been declining, hepatitis B and C viruses can persist as chronic infections. Both infections are leading causes of chronic liver disease and liver cancer in the United States. 

Liver Function 

The liver is a football-sized organ that weighs about 3 pounds. It is located in the right upper abdomen and plays an important role in many body processes, including:

• Digestion

• Filtering toxins

• Regulating blood sugar

• Protein metabolism

• Processing hemoglobin and storing iron

• Blood clotting

• Preventing infections

• Clearing bilirubin 

How Does Hepatitis Impact Liver Health?  

Acute hepatitis starts suddenly and gets better quickly. Chronic hepatitis can develop slowly and become a long-term condition. This can lead to liver damage, including cirrhosis, liver failure, liver cancer, and even death.

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How Do You Get Hepatitis?

Common causes of hepatitis include:

• Viral hepatitis, with the 5 most common types: A, B, C, D, and E

• Alcohol-associated hepatitis 

• Non-alcoholic fatty liver disease

• Toxins and drugs

Other causes of hepatitis include: 

• Autoimmune disorders

• Genetic liver disorders 

• Rare viral infections (e.g. infectious mononucleosis, yellow fever, cytomegalovirus infection) and leptospirosis

• Bacterial and parasitic infections 

Hepatitis A and E are acute (short-term) viral infections that are usually transmitted through contaminated food or water. The main sources of hepatitis viruses A and E are:

• Raw or undercooked food

• Food handled by people with unwashed hands

• Water contaminated with human fecal matter or animal waste

What Are The Symptoms of Hepatitis?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), hepatitis can be asymptomatic. However, when hepatitis symptoms occur, they can include:

• Jaundice (yellow discoloration seen in the eyes and skin)

• Loss of appetite

• Nausea and vomiting

• Abdominal pain

• Diarrhea

• Fever

• Dark urine

• Clay-colored stool

• Joint pain

Chronic infection and inflammation of the liver can result in extensive scarring of the liver (cirrhosis) and impaired liver function. 

How Is Hepatitis Diagnosed?

Initial Evaluation

Your doctor may suspect hepatitis based on your symptoms, medical history, and physical exam. Acute liver infection is the usual suspect when patients have symptoms like fatigue, loss of appetite, and jaundice. 

Blood Tests for Hepatitis Diagnosis

Blood tests such as comprehensive metabolic panel, liver panel (liver function tests), toxin screening, can help to find out the type and severity of hepatitis. Virus hepatitis can be diagnosed based on the presence of specific antibodies (proteins) in the blood that the immune system makes to fight off the infection. 

If blood tests do not show any evidence of viral infection, a detailed medical history and screening for toxins and alcohol may point toward other causes of hepatitis. 

Imaging Tests

Doctors might also do imaging tests, such as an ultrasound, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan, to reach a diagnosis.

Further Testing

Health care providers may also suggest performing a liver biopsy if chronic hepatitis B or chronic hepatitis C are suspected and there's a chance of liver damage from the infection hepatitis.

Screening for Hepatitis

Since liver damage can occur before any severe signs and symptoms, routine screenings for hepatitis B and hepatitis C are recommended for people at a high risk of contracting these viruses. 

Risk factors include: 

• Intravenous drug users

• Those with multiple sexual partners

• People who have had sex with an infected person

• Men who have sex with men

• People who take immunosuppressive drugs

• HIV-positive patients

• Pregnant women

These high-risk individuals should undergo regular testing for liver disease, including hepatitis B and C (virus hepatitis).

Types of Viral Hepatitis  

According to the Centers for Disease Control and Prevention (CDC), these are the types of viral hepatitis and their symptoms and transmission methods.

Hepatitis A and E

Hepatitis A and E are transmitted through the fecal-oral route (contaminated food and water).

Hepatitis A is common, and symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever. Usually, a hepatitis A infection clears on its own in one or two months. Hepatitis A treatment includes rest and adequate hydration. 

Hepatitis E is common in tropical regions and developing countries where hepatitis spreads due to poor sanitation. 

Hepatitis B

Hepatitis B infection is a vaccine-preventable liver infection. It is caused by the hepatitis B virus (HBV) and is transmitted through direct contact with an infected person’s blood, semen, or other body fluids entering the body of a healthy person. This can happen through: 

• Sexual contact

• Shared needles, syringes, or drug injection equipment

• From mother to baby at childbirth

Learn more about hepatitis in children.

Newly infected people may not have hepatitis B symptoms, but for those that do, symptoms can include fatigue, nausea, poor appetite, stomach pain, and jaundice. 

For many people, hepatitis B is a short-term illness. However, some people can develop a chronic (long-term) infection that can lead to serious, even life-threatening health issues like cirrhosis or liver cancer. 

The risk for chronic disease is linked to age at infection: about 90% of infants with hepatitis B develop chronic illness, whereas only 2% to 6% of people who get hepatitis B as adults become chronically infected. (Hepatitis B, 2020) 

Currently, there is no evidence that hepatitis B is curable, but it is manageable. Active and extensive research is being conducted to search for a hepatitis B cure; until then, the best way to prevent this is to get the hepatitis B vaccine.

Hepatitis C

Hepatitis C is mainly transmitted through contact with the blood of an infected person. For example, transmission can occur when people share needles for drug injections. Less frequently, the hepatitis C virus (HCV) can also spread through sexual contact or childbirth. 

Most people have no hepatitis C symptoms, but those who develop symptoms may have fatigue, nausea, loss of appetite, and yellow discoloration seen in the eyes and skin. 

Hepatitis D

Hepatitis D spreads through contact with blood. Infections with this virus only occur when someone is already infected with hepatitis B. Injection drug users are at the most significant risk for this type of hepatitis.

How Can Hepatitis Be Prevented?

Lifestyle Changes

There are various ways to prevent or lower the risk of hepatitis. For example:

• Reducing alcohol intake can prevent alcohol-associated hepatitis. 

• Taking over-the-counter medications such as acetaminophen (Tylenol) at the recommended dose can prevent drug-induced hepatitis.

• Following safety precautions in the workplace can prevent toxin exposure-related hepatitis.

• Practicing safe sex can lower the risk of hepatitis B in sexually active adults.

• Avoiding sharing personal items such as toothbrushes and razors can prevent hepatitis B and C.

• Following food safety habits can prevent transmission of hepatitis A and E.

Note: There is no way to prevent certain types of hepatitis, such as autoimmune hepatitis or hepatitis linked to rare genetic disorders. Early diagnosis, treatment, and monitoring can help to manage hepatitis symptoms and slow or prevent liver damage.

Other Preventive Measures

Screening of donated blood, proper disposal of used needles, and avoiding shared drug injection equipment are recommended to prevent the spread of hepatitis. 

Vaccination 

There are vaccines to prevent both hepatitis A and B. Currently, there is no vaccine developed for hepatitis D, but the disease can be prevented by vaccinating against hepatitis B.

Hepatitis A Vaccine

According to the CDC, routine administration of the hepatitis A vaccine in childhood, which was implemented in many parts of the United States in the 1990s, has significantly reduced new cases of hepatitis A by 95% between 1995 (12 cases per 100,000 people ) and 2010 (less than 1 case per 100,000 people). 

Hepatitis B Prophylaxis

Hepatitis B vaccination is readily available. It is 95% effective in preventing viral infections and their chronic consequences, according to the WHO. 

The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B (HepB) vaccination for all infants at birth, unvaccinated children under 19 years of age, adults aged 19 to 59 years, and adults over 60 years with risk factors for hepatitis B.

Myths and Misconceptions About Hepatitis

There are several common misconceptions about hepatitis, including:

Myth: Hepatitis is a single disease.
Fact: There are many types of hepatitis, including viral hepatitis, alcoholic hepatitis, and drug-induced hepatitis.

Myth: Hepatitis is hereditary.
Fact: Hepatitis itself is not a genetic disease, but infectious hepatitis can be passed from mother to child during childbirth. Hepatitis also develops in people with certain rare genetic disorders.

Myth: Hepatitis is untreatable.
Fact: It’s true that there’s no cure for hepatitis, but it can be treated with antiviral medications. Some types of hepatitis can heal on their own, while others can progress to liver cirrhosis.

Hepatitis in Pregnant Women

Acute hepatitis A virus infection during pregnancy might increase the rates of adverse pregnancy outcomes. There are reports of fetal liver injury and mother-to-child transmission of hepatitis A (HAV). In addition, pregnant people with chronic hepatitis B or C infection might have an increased risk of preterm delivery and gestational diabetes. 

There is a risk of mother-to-child transmission of hepatitis B virus (HBV), especially in mothers with high HBV DNA levels. This risk can be reduced by using maternal antiviral therapy and prompt administration of infant immunoprophylaxis. According to the National Institutes of Health (NIH), babies born to mothers infected with hepatitis B should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

Acute hepatitis E virus infection in pregnancy is linked with an increased risk of maternal death and infant mortality, including higher rates of preterm delivery and stillbirths. 

Treatment Options for Hepatitis

Treatment for hepatitis typically depends on the type and whether it is acute or chronic. Very often, acute viral hepatitis goes away on its own. You may need to rest, eat well, and get enough fluids. However, in severe cases, hospitalization might be required.

There are several medicines used to treat hepatitis if it is chronic (long-term). Other than drug treatments, surgery and other medical procedures may be necessary. If chronic hepatitis leads to liver failure or liver cancer, a liver transplant may be needed.

Lifestyle Changes

• Alcoholic hepatitis: People with alcoholic hepatitis need to stop their alcohol intake. 

• Toxin-induced hepatitis: The most effective treatment for hepatitis caused by toxins or alcohol is to avoid further exposure to the harmful chemicals, drugs, or supplements causing toxic hepatitis. You must avoid or limit workplace exposure to harmful chemicals. If it is confirmed that you developed toxic hepatitis after exposure to harmful chemicals, a change of jobs or duties is recommended. 

• Recreational drugs: You should not use recreational drugs that can cause liver injury. 

• Drug-induced hepatitis: It’s important to take prescription and over-the-counter medications as directed (do not take more than the recommended dose of medications).

Antiviral Medications for Chronic Hepatitis B and Hepatitis C

According to the NIH, most acute hepatitis infections brought on by the hepatitis A, B, C, and E virus will resolve on their own over several weeks or months. 

Treatment for chronic hepatitis B and C infections include: 

• Antiviral medications such as pegylated interferon (peginterferon) injections for hepatitis B may be used in some cases.

• Oral antivirals for chronic hepatitis B infection include lamivudine, tenofovir, and entecavir. 

• Direct-acting antivirals (DAAs) for hepatitis C include elbasvir/grazoprevir (Zepatier), ledipasvir/sofosbuvir (Harvoni), sofosbuvir/velpatasvir (Epclusa). 

• The previously recommended treatment for hepatitis C included ribavirin with interferon alfa. However, this method is less effective than DAAs and has more side effects. Therefore, it is no longer advised for patients with hepatitis C. 

Even though there is no vaccine for hepatitis C, treatments can reduce the viral load to undetectable levels, which is considered cured or in remission. Hepatitis C is considered cured when it is not detected in your blood 12 weeks after treatment is completed.

Liver Transplant

Liver transplantation may be necessary if the liver is severely damaged.

Advances In Hepatitis Cure  

Some of the drugs and vaccines in clinical trials that may be a cure for hepatitis in the coming years include:

• Bepirovirsen — an antisense oligonucleotide in Phase III clinical trials for the treatment of chronic hepatitis B. This medication is designed by GSK to target the virus’s genetic material, allowing the immune system to gain control over the infection. 

• TherVacB vaccine — a novel therapeutic vaccine to combat chronic hepatitis B. The TherVacB clinical trial was planned to start in January 2025. 

Living With Hepatitis   

Can Hepatitis Be Cured?

Hepatitis cannot be cured, but there are ways to prevent further liver inflammation and long-term damage and manage hepatitis symptoms, including lifestyle changes (stopping alcohol consumption) and antiviral therapies. 

Do People Live With Hepatitis?

Most people with hepatitis live full, long lives. There is no cure for hepatitis, but regular monitoring and treatment can help to manage the symptoms of hepatitis and limit the damage it causes. 

FAQ About Hepatitis Symptoms, Causes, and Treatments

How Do You Get Rid of Hepatitis?

There is no cure for viral hepatitis. Once you get the infection, you have it lifelong. Treatment is geared towards preventing further liver damage and providing symptom relief. Most cases of acute hepatitis resolve with time. Chronic hepatitis may need to be treated with antiviral medications. For people with autoimmune hepatitis, certain medications can be used to keep the overactive immune system in check. It’s important to keep all your medical and laboratory appointments if you have chronic hepatitis to ensure the condition is managed properly.

Is Hepatitis A Virus or an STD?

Hepatitis A is a viral infection. It is not recognized as an STD (sexually transmitted disease). Hepatitis A spreads through the feco-oral route (through the consumption of food and water contaminated with fecal matter from an infected person). 

Can Hepatitis A Go Away?

Yes, hepatitis A typically clears up on its own within a few months with supportive treatment options. 

Is Hepatitis Contagious?

Some types of hepatitis are contagious, for example, viral hepatitis caused by the hepatitis A, B, C, D, or E viruses. Other types of hepatitis are not contagious, for example, hepatitis caused by alcohol abuse, drug-induced hepatitis, and autoimmune hepatitis. 

What Is The Main Cause of Hepatitis?

The main causes of hepatitis are: 

• Viruses: Hepatitis A, B, C, D, and E are the five main types of hepatitis viruses. Hepatitis A and E are caused by contaminated food or water, while hepatitis B, C, and D are usually caused by contact with infected body fluids. In addition, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) can cause acute hepatitis in some people.

• Alcohol: Heavy alcohol use can cause alcohol-associated hepatitis, which can be acute or chronic. Find out the health benefits of quitting alcohol.

• Metabolic syndrome: Metabolic dysfunction associated steatohepatitis (MDASH) is an advanced stage of fatty liver disease with liver inflammation. It is caused by metabolic risk factors such as high cholesterol, high blood pressure, high blood sugar, and obesity.

• Drugs: Certain drugs, including over-the-counter medications such as acetaminophen and prescription drugs (anabolic steroids, certain antibiotics, oral contraceptives, statins, sulfa medications, antiepileptic drugs) and herbal remedies, can cause drug-induced hepatitis. 

• Autoimmune disease: Autoimmune hepatitis is a chronic hepatitis that occurs when the body's immune system attacks healthy liver cells. The exact cause is unknown, but both genetics and environment may play a role. 

• Toxin exposure: Exposure to industrial chemicals such as carbon tetrachloride and vinyl chloride, herbicides and pesticides can cause toxic hepatitis.

• Inherited disorders: Certain rare genetic disorders like hemochromatosis, Wilson disease, glycogen storage disease, and Gaucher disease can cause hepatitis.