Liver Disease

Hepatitis A

Hepatitis A is a contagious liver disease that is a result of infection with the hepatitis A virus. Hepatitis A is self-limited in most cases. People who get hepatitis A may feel sick for a few weeks to several months but usually recover completely and do not have lasting liver damage.

The hepatitis A virus is spread when someone ingests the virus, usually through:

Eating contaminated food or drink
Person-to-person contact; caring for someone who is ill and also can be transmitted by sexual contact.

Hepatitis A can be prevented with a safe and effective vaccine and also handwashing plays an important role in prevention.

Hepatitis B

Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

Hepatitis B is usually spread when blood, genital secretions, or body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person, sharing razors, needles, syringes, or other drug-injection equipment; but it cannot be transmitted by household contacts such as sharing other items such as drinking glasses, silverware or using the same bathroom. Hepatitis B can also be passed from an infected mother to her baby at birth.

Type of Hepatitis B

Hepatitis B can be either acute or chronic.

Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.

Chronic Hepatitis B is a potentially serious disease that can result in long-term health problems such as liver cirrhosis, liver cancer and even death.

Treatment Options

There is no specific treatment recommended for acute — short term illness — Hepatitis B; in 95% of adults, the immune system controls the infection and builds immunity within about six months.

In people who develop chronic — long term illness — Hepatitis B, an antiviral medication might be recommended to reduce or reverse liver damage and to prevent long-term complications of Hepatitis B.

Several antiviral medicines are available to treat Hepatitis B effectively. Not all people with Hepatitis B need immediate treatment. If you do not start treatment immediately, you will be monitored over time to know when hepatitis becomes more active (meaning that antiviral treatment should begin).

Once you start treatment, you will have regular monitoring to see how well the treatment is working, monitor for side effects, drug resistance, and adherence to treatment. In most patients antiviral medications (pills) need to be provided indefinitely. For those patients requiring indefinite therapy there are currently investigational treatments aiming to put the virus in remission or functionally cured so they don’t have to take a daily pill.

Prevention of Hepatitis B

The best way to prevent Hepatitis B is by getting vaccinated. The current Hepatitis B vaccine, usually a two or three-dose series is recommended for all children 0-18 years of age. Adults at increased risk of acquiring Hepatitis B infection should receive this vaccine.

This population includes but is not limited to:

People with liver diseases, including those infected with Hepatitis C
Healthcare workers
Sexually active people who are not in long-term, mutually monogamous relationships
People seeking evaluation or treatment for a sexually transmitted disease
Household members and sex partners of people with chronic Hepatitis B infection
In addition, the vaccine can be given to any person who desires protection from Hepatitis B.

Hepatitis C

Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected.

Many people have become infected with the hepatitis C mainly by coming in contact inadvertently with this virus. This could have occurred by sharing needles, or other equipment potentially contaminated with this virus, such as drug paraphernalia, instruments in tattoo parlors, sharp household contaminated instruments (razors) and from contaminated blood products such as in blood transfusions and organ transplants. Healthcare workers, such as nurses and accident first responders, are also at risk.

In 1992, a widespread screening of the blood supply began in the United States. Today, blood banks go through great length to test their blood supplies and to make sure their blood products are safe which has helped tremendously to reduce the transmission of this infection. Although much less frequent, sexual exposures can also result in transmission of hepatitis C virus.

Acute Versus Chronic Heptatitis C

Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. In about 20% of the infected people the body’s immune system clears the infection spontaneously. These are “lucky” individuals, although their hepatitis C screen test is always positive, they do not have active infection, nor can they pass the infection or need treatment.

For the remaining 80% of the infected people, the acute hepatitis C leads to chronic infection. People with chronic hepatitis C progress very slowly, and it can take decades from the time of the original infection to the development of some liver problems. During all that time, the person may be completely asymptomatic and unaware of the infection. However, chronic hepatitis C is a serious disease than can potentially result in long-term health problems such as liver cirrhosis, liver cancer and even death if left untreated.

Types of Genotypes of Hepatitis C

There are different genotypes (GT) of hepatitis C with different geographic distributions. In the United States genotypes 1a and 1b are the most common (about 75% of cases) with genotypes 2 and 3 present in only 10 to 20% of patients. Other GTs are rarely seen in the US. Current treatments treat and cure all kinds of genotypes.

Treatment of Hepatitis C

Hepatitis C infection is a curable disease in almost all cases. The goal of hepatitis C treatment is to prevent worsening of liver disease by permanently eradicating the virus from the body.

Hepatitis C treatment has changed dramatically in the last decade. Cure rates are much higher, approaching 98% – 100%. The side effect profile and safety of treatments available has significantly improved allowing most people to continue activities of daily living, including full-time employment, while receiving anti-HCV treatment.

Most people treated today for HCV can be cured in a short period of time, from 8 to 12 weeks. Cure for HCV does not revert the commonly used HCV antibody-test to negative. A person with a past HCV infection that is now cured will remain with a positive HCV antibody-test despite the lack of virus. Cure for HCV does not confer immunity (or future protection against re-infection), so a person initially infected, treated and cured, can still become re-infected if that person again gets exposed to a new HCV. The best way to determine if a person previously cured has been re-infected with HCV is by obtaining a HCV-RNA PCR (or a HCV viral load). There is no vaccine for hepatitis C. The best way to prevent it is by avoiding behaviors that can spread the disease.

Hepatitis D

Hepatitis D, also known as “delta hepatitis,” is a liver infection caused by the hepatitis D virus (HDV). Hepatitis D only occurs in people who are also infected with the hepatitis B virus. Hepatitis D is spread when blood or other body fluids from a person infected with the virus enters the body of someone who is not infected. One in 20 people with hepatitis B are estimated to be coinfected with hepatitis D.

Hepatitis E

Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). HEV is found in the stool of an infected person. It spreads when someone inadvertently ingests the virus. In developing countries, people most often get hepatitis E from drinking water contaminated by feces from people who are infected with the virus. In the United States and other developed countries where hepatitis E is not common, people have gotten sick with hepatitis E after eating raw or undercooked pork, venison, wild boar meat, or shellfish. Most people recover fully from the disease without any complications.

Other Viral Infectious Hepatitis

Non-Viral Infectious Hepatitis

Some bacterial infections known to affect other body systems occasionally can affect the liver as well. i.e., Syphilis, Rickettsia, Leptospirosis, among others. Bacterial infections can be treated with antibiotics.

Non-alcoholic Fatty Liver

Non-alcoholic fatty liver disease or NAFLD is when fat is increased in the liver and there is not a clear cause such as excessive alcohol use. The fat deposits can cause liver damage.

NAFLD is divided into two types: simple fatty liver and nonalcoholic steatohepatitis (NASH). Most people with NAFLD have simple fatty liver, however 25-30% have NASH. With NASH, there is inflammation and scarring of the liver. A small number of people will develop significant scarring in their liver, called cirrhosis.

There are no specific medications to treat fatty liver therefore the treatment is targeted to improve the person’s lifestyle and treatment of underlying conditions. Exercise, weight loss, alcohol avoidance, treatment of high blood sugar and/or high cholesterol are the most important interventions to improve fatty liver.

H. Pylori

Helicobacter pylori (H. pylori) infection occurs when H. pylori bacteria infect the lining of your stomach. This usually happens during childhood but can happen at any age. A common cause of stomach ulcers (peptic ulcers), H. pylori infection may be present in more than half the people in the world.
Most people don't realize they have H. pylori infection because they never get sick from it.
H. pylori can be treated successfully with antibiotics.

Symptoms: Most people with H. pylori infection will never have any signs or symptoms. It's not clear why many people don't have symptoms. But some people may be born with more resistance to the harmful effects of H. pylori.
Common symptoms when present are:

An ache or burning pain in your stomach (abdomen)
Stomach pain that may be worse when your stomach is empty.
Nausea
Loss of appetite
Frequent burping
Bloating
Unintentional weight loss

FAQs

Can my HCV test be wrong (falsely positive)?

Yes, your HCV antibody test could be a false positive test, which means the test looks as if it is positive, but it is really negative. This happens more often in people who have a low risk for the disease for which they are being tested. Sometimes there could be some blood reactants that can turn a screening test positive.

It is very important that a case of a false positive test is confirmed with a more sophisticated test and repeat at least twice over a period of time. Only a qualified physician in the evaluation and management of Hepatitis C should be able to determine if your test is a false positive or not. By far, most positive HCV antibody tests are indeed truly positive, even in a person with unknown risk factors.

What are the chance I may need treatment?

What lab work is my doctor going to order?

What are liver function tests or liver enzymes?

Liver function tests (LFT’s), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient’s liver. These tests can be used to (1) detect the presence of liver disease, (2) distinguish among different types of liver disorders, (3) gauge the extent of known liver damage, and (4) follow the response to treatment. ALT and AST are enzymes present in hepatocytes (liver cells). When a liver cell (hepatocyte) is damaged, it leaks these enzymes into the blood, where they can be measured. ALT and AST levels rise frequently on patients with chronic viral hepatitis, and other conditions, such as alcohol use. A normal level should be interpreted with carefulness because it does not always correlate with a healthy liver.

What is a Hepatitis C viral load?

Your viral load is the amount of specific viruses that you have, in a given volume of your blood (usually 1 milliliter = 1 cubic centimeter). More precisely, it means that the amount of Hepatitis C genetic material found in your blood corresponds to as many Hepatitis C viruses as the given number says.

Viral load varies between infected individuals and varies from time to time in the same individual. Your viral load becomes useful for your doctor to follow and monitor the response to Hepatitis C treatment and cure.

What is a Hepatitis C genotype?

Do I need a liver biopsy and is it safe?

Liver biopsies for HCV evaluation are becoming less necessary. There are other non-invasive staging methods such as laboratory fibrosis score (blood sample collection) and transient elastography (fibroscan) that can assist the provider in determining the extent of liver damage. Rarely, a liver biopsy is still required; this biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. A liver biopsy may be recommended to diagnose a problem or to determine the severity of liver disease. As a general rule, a liver biopsy is recommended only when the results would affect the planned treatment or management.

What is Cirrhosis?

Cirrhosis is the term used to describe a diseased liver that has been severely scarred, usually due to many years of continuous injury. The most common causes of cirrhosis include fatty liver disease, longstanding alcohol abuse, hepatitis B or hepatitis C. Although cirrhosis cannot be cured, there are a number of things you can do to prevent the disease from worsening. Patients with cirrhosis are at higher risk of liver cancer therefore they need to have surveillance lifelong for prompt identification and treatment.

Can I try herbal treatment?

Many herbal products claim that they may help to detoxify the liver, and in patients with significant liver inflammation it is possible that some of these agents may be marginally effective in decreasing liver inflammation, but they do not cure the virus. Many herbal products claim to “cure” or improve hepatitis C; none of these claims have been proven true. In addition, some herbal medications can seriously injure the liver.

What if I tried treatment in the past and I did not respond?

Will I need a liver transplant?

Your doctor should be able to determine when you need to be considered for liver transplant consultation. Patients are considered for liver transplant when there is irreparable damage to the liver that leads to permanent impairment of its regular function jeopardizing the patient’s life. In adults, the most common reason for a liver transplant is cirrhosis. Cirrhosis is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. The transplant process is elaborate, involving an extensive screening process for eligibility. Thus, not all patients with cirrhosis are eligible, and only those with the most advanced, severe cirrhosis are placed on the transplant registry.