Types of Viral Hepatitis: Know the Risks, Symptoms and Treatment

July 26, 2018 12:38 PM

Rates of infection are increasing worldwide and you could be harboring the virus without knowing it. Learn what to look for and how to get tested.

HEP B

Globally, while deaths from tuberculosis, HIV and malaria have been declining in recent years, deaths from viral hepatitis are increasing, says Anna Lok, M.D., a Michigan Medicine hepatologist who researches hepatitis treatments and cures.

“Viral hepatitis remains one of the most common infections worldwide,” Lok says. “Having one day each year dedicated to this reminds us the entire global community needs to work together to eliminate the virus.”

Today is World Hepatitis Day. July 28 was the birthday of Baruch Blumberg, M.D., who won a Nobel Prize for discovering the hepatitis B virus.

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What to know

Viral hepatitis types include A, B, C, D and E, and the effects of chronic hepatitis can be deadly.

“The recent hepatitis A outbreak in Michigan could’ve been prevented if everyone was vaccinated,” Lok says. “Although hepatitis B vaccinations for all newborns, children and adolescents have been recommended for more than 20 years, very few adults have been vaccinated and fewer than 1 in 4 adults in the United States have immunity to the hepatitis B virus. With the recent opioid epidemic, there have been new cases of hepatitis B and C as well.”

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The World Health Organization reports that hepatitis B and C alone affect about 325 million people worldwide.

Types of viral hepatitis

Hepatitis can be either acute or chronic.

Symptoms of acute hepatitis are often overlooked, like fatigue, decreased appetite, nausea and upper right abdominal discomfort, Lok says. More severe cases may include dark urine or jaundice. Acute hepatitis can cause severe illness that lasts for a few months and, in rare cases, contributes to acute liver failure and death.

Chronic hepatitis lasts longer than six months and often displays no symptoms until later, but the most common symptom is fatigue. This form of hepatitis can lead to cirrhosis, liver failure and liver cancer.

It can be overwhelming and confusing to differentiate between the types of hepatitis and figure out your options. This might make it easier:

  • Hepatitis A does not progress to a chronic illness. The vast majority of patients recover on their own, but a small number, particularly older adults, can develop acute liver failure and die. Vaccination can prevent hepatitis A.

  • Hepatitis B can go on to become a chronic illness. It can be suppressed using oral anti-viral drugs, but current drugs are not curative and patients often need treatment long term. The drug interferon is sometimes used. A small percentage of patients can experience a long-lasting response, but interferon has to be given as injections and has many side effects. Vaccination can prevent hepatitis B.

  • Hepatitis C can progress to a chronic illness. It can be cured (for about 95 percent of patients) using oral direct-acting anti-viral drugs. There are lower rates of cure for patients diagnosed late with advanced cirrhosis. There is no vaccination for hepatitis C.

  • Hepatitis D also can progress to a chronic illness. It occurs only in the presence of hepatitis B. Vaccination against hepatitis B can prevent hepatitis D.

  • Hepatitis E does not progress to a chronic illness except in rare cases in immunosuppressed people. There is a vaccine for hepatitis E in some countries but not in the United States.

A look at hepatitis B

Recent media coverage has focused on hepatitis A and C, but it’s important that people understand the B virus as well.

The hepatitis B virus is spread when blood, semen or another bodily fluid from a person infected with the hepatitis B virus enters the body of a person who is not infected. A pregnant mother with the virus can spread it to her child, or it can be contracted through sex with an infected partner. Sharing needles, syringes or drug preparation equipment also contributes to the spread of hepatitis B.

Lok says hepatitis B is more common among people born outside the U.S., in particular Asia and Africa.

“In Asian countries, hepatitis B is most often spread from the infected mother to the newborn. Many times, foreign-born persons get the infection before they migrate to the U.S.,” Lok says.

The hepatitis B virus can become integrated into human DNA or stay in a stable state in the liver cell nucleus. This makes the virus tough to attack with anti-viral drugs and makes finding a cure difficult.

Dr. Lok
"Viral hepatitis remains one of the most common infections worldwide. Having one day each year dedicated to this reminds us the entire global community needs to work together to eliminate the virus."
Anna Lok, M.D.

What now?

Lok says a simple blood enzyme test can confirm a liver injury. The most common tests include the aspartate aminotransferase (AST) test and the alanine aminotransferase (ALT) test. A blood sample also can help identify the cause of the hepatitis.

People who have risk factors for hepatitis should have blood tests to determine whether they are infected, even if they do not have symptoms or their AST and ALT tests are normal, because liver injury may wax and wane.

If you don’t have hepatitis, get vaccinated. Being more health conscious, like eating healthy foods and exercising regularly, can also help prevent hepatitis.

“Prevention is always better than the cure,” Lok says. “There are safe, effective vaccines that can prevent hepatitis A, B and D. However, there isn’t a vaccine for hepatitis C, and the vaccine for hepatitis E is not FDA-approved or available in the U.S.”

“Raise awareness of this virus. Screen those at risk, vaccinate those susceptible and treat chronic infection is indicated,” says Lok, who has been involved in developing the American Association for the Study of Liver Diseases guidelines since 2001.

To make an appointment to discuss hepatitis concerns or treatment, call Michigan Medicine’s Hepatology Program at 844-233-0433.