Disease and Condition

From About.com
Updated: June 29, 2006
About.com Health's Disease and Condition content is reviewed

What is Hepatitis?

Hepatitis means inflammation (itis) of the liver (hepar), an irritation or swelling of the liver cells. There are many causes of hepatitis which include viral infections A, B and C that most of us have heard of, but also the disease also includes auto-immune hepatitis, fatty liver hepatitis, alcoholic hepatitis and toxin induced hepatitis. Globally, it is estimated that around 250 million people are affected by hepatitis C. Moreover, an estimated 400 million people are chronic carriers of hepatitis B.

How Big is the Hepatitis Problem?
Hepatitis is an enormous health issue; so extensive in fact that there is a good chance you associate with at least one or more people with hepatitis. There is an equally high chance that you know nothing about them because with hepatitis comes a stigma. Often people with hepatitis find it easier to get on with their life by not informing others. This is mainly due to the difficulties they can experience due to the ignorance of others. The problem may however be compounded by the fact that some forms of hepatitis are infectious. However, people who know they have infectious hepatitis need only take a few basic precautions to avoid passing the infection around.

The Liver.
Hepatitis affects the liver. The liver is a wedge shaped organ located on the upper right side of the body, lying beneath the rib cage. The largest organ it makes up 2 to 3 per cent of the body’s total weight. Unlike the heart or stomach, the liver has no one function. Doctors specialising in the liver, hepatologists, believe that it has over 140 functions. These include producing bile needed for digestion, storing minerals and vitamins, assisting in blood clotting (vitamin K), neutralising poisons, producing amino acids to build healthy muscles, regulating energy, maintaining hormonal balance, processing drugs. When someone gets hepatitis the function of the liver is compromised and the functions of it can be affected to varying degrees.

The History of Hepatitis
Hepatitis was believed to exist in viral form from ancient times. It is known that a disease existed that affected the liver and caused yellowing of the skin (jaundice). Between the 1800s and early 1900s, 2 types were identified as either serum type or viral type. In 1963 there was a major breakthrough which identified the cause of serum hepatitis and named the hepatitis B virus (HBV). Ten years later the cause of infectious hepatitis was found and named the Hepatitis A virus (HAV), and although scientists knew other viruses existed it was not until 1989 that the hepatitis C virus (HCV) was isolated.

Although the hepatitis delta virus (HDV) was known about since the mid 1970s, it was only in the late 1980s -1990s that it was understood to exist only in the presence of hepatitis B. In 1990, hepatitis E virus (HEV) and in 1995, Hepatitis G virus (HGV), were identified. Other viruses, hepatitis F virus (HFV) and transfusion transmission virus (TTV) are thought to exist, but are not as yet proven.

Viral Hepatitis
Each type of viral hepatitis is different. They have different characteristics and are known by alphabetical names - hepatitis A through to E. Four other types exist F, G, TTV (Transfusion Transmitted Virus) and S.E.N-V (these are the initials of the person in which this form of the virus was first identified - V standing for virus). Behavioral precautions and treatment depends on the type of hepatitis.

Types of Hepatitis

Types of Viral Hepatitis
Hepatitis is categorized according to disease type. Each type of viral hepatitis is different, they have different characteristics and are known by alphabetical names, hepatitis A, hepatitis B,C,D,E,F and G, TTV and S.E.N-V. In this article I look at two of the three most common forms of Hepatitis, Hepatitis A and Hepatitis B.

Hepatitis A Virus (HAV)
Hepatitis A is an inflammation of the liver due to the A type virus and is commonly known as infectious hepatitis. It is thought of as the least serious form of hepatitis as the person infected never goes on to experience the chronic form of the disease. People with this type of hepatitis generally make a full recovery. People with hepatitis A feel pretty awful, rather like experiencing a severe flu with jaundice (yellowing of the skin and whites of the eyes caused by the accumulation of the yellow/brown color bile pigment 'bilirubin' in the blood). A small percentage of infected people, notably the elderly or those with pre-existing liver disease, are at risk of experiencing severe symptoms of acute hepatitis and may become so ill that they require a liver transplant. Hepatitis A will not lead on to liver cancer or cirrhosis. Vaccine is available and is advisable for certain groups of people, workers and when traveling to various countries around the world.

Hepatitis B Virus (HBV)
Of the adults who get the Hepatitis B virus, 95%, clear the virus and do not go on to have the chronic form of the disease. Some people have few or no symptoms so may not realize they have HBV or that they have had it. Many adults will clear the virus completely within 6 months and protective antibodies mean they will never have to worry about HBV again as they are immune. Of the 200,000 Americans who contract hepatitis B each year, 10,000 to 15,000 go on to develop a chronic form of the disease. Men are 6 times more likely than women to become chronic carriers of HBV. The reason for this is unclear. Chronic hepatitis is divided into 3 categories, healthy chronic carrier of hepatitis B, chronic infectious hepatitis B and chronic mutant hepatitis B.

Chronic Infectious Hepatitis B
In this type of hepatitis the person is highly infectious to others. They have very inflamed and damaged livers even when presenting with few or no symptoms. People with this type of hepatitis B are more likely to have a progressive disease leading to cirrhosis. Only 5% to 10% have a spontaneous remission, become non infectious to others and sustain no further or minimal liver damage, although sometimes reactivation of the virus occurs.

Healthy chronic carriers
Healthy chronic carriers are not infectious to others and although they may have a slightly higher risk of cirrhosis and liver cancer than the general population, they mostly live a normal life. The virus can become reactivated when their immune systems become suppressed, such as during treatment with immunosuppressant drugs for diseases like cancer, AIDS, with drugs such as steroids and sometimes during other severe illnesses.

Chronic Mutant Hepatitis B:
In this form the person has a mutant strain, a permanent alteration of the hepatitis B virus’s genetic makeup. They have the potential to be infectious to others and it is thought to be more resistive to treatment than the other forms of the disease.

Information about chronic hepatitis B
# Approximately 2% of chronic hepatitis B sufferers each year go on to develop cirrhosis.

# The cumulative probability over 5 years of developing cirrhosis is therefore 15% to 20%.

# The 5 year survival rate after cirrhosis develops is between 52% and 80%.

# If decompensated cirrhosis develops survival rates decrease to between 14% and 32%.

Prognosis Hepatitis B
Those with a less favourable prognosis include
People with poor general health
The elderly
People infected with hepatitis D and hepatitis B
People infected with hepatitis C as well as hepatitis B
People who are diagnosed with advanced hepatitis when they come to the attention of doctors
People who continue to drink alcohol after a diagnosis of chronic hepatitis.

There is an increased risk of liver cancer.

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