Meaning literally inflammation of the liver, hepatitis refers to a group of conditions, most of which are caused by one of many viruses. Hepatitis can also be inherited (congenital hepatitis), autoimmune in nature (the body attacks its own liver), or brought on by excess alcohol consumption.

After initial exposure to a virus, viral hepatitis can be cleared from the body by the immune system in a period ranging from weeks to months.  However in many cases it persists and becomes chronic (chronic hepatitis).  In this situation, it must be managed medically. The most well-known forms of chronic hepatitis are hepatitis B and hepatitis C.

Types of Hepatitis

Hepatitis – inflammation of the liver that sometimes causes permanent damage; caused by viruses, drugs, alcohol, or parasites. Hepatitis has the following forms:

Hepatitis A – a form of infectious hepatitis caused by the hepatitis A virus. The virus may be spread by fecal-oral contact, fecal-infected food or water, and may also be spread by a blood-borne infection (which is rare).

Hepatitis B – a form of infectious hepatitis caused by the hepatitis B virus. Transmission of the hepatitis B virus occurs through blood and body fluid exposure, such as blood, semen, vaginal secretions, or saliva.

Hepatitis C – a form of infectious hepatitis caused by the hepatitis C virus. Transmission of the hepatitis C virus occurs primarily from contact with infected blood, but can also occur from sexual contact or from an infected mother to her baby.

Hepatitis D – a form of infectious hepatitis caused by the hepatitis (Delta) virus. This form of hepatitis can only occur in the presence of hepatitis B. Transmission of hepatitis D occurs the same way as hepatitis B.

Hepatitis E – a form of infectious hepatitis caused by the hepatitis E virus. This form of hepatitis is similar to hepatitis A. Transmission occurs through fecal-oral contamination. Hepatitis E is most common in poorly developed countries and is rarely seen in the US.

Hepatitis G – the newest form of infectious hepatitis. Transmission is believed to occur through blood and is seen in IV drug users, individuals with clotting disorders, such as hemophilia, and individuals who require hemodialysis for renal failure.

Hepatitis B and Hepatitis C

Hepatitis B is caused by a HBV, "hepatitis B virus," a member of the hepadnavirus family. Spread through contact with blood, it has symptoms in its acute stage. Chronic hepatitis B can leads to cirrhosis as well as liver cancer.

Hepatitis C is caused by HCV, "hepatitis C virus," a member of the Flavivirus family. Spread through contact with infected blood, the disease can also lead to cirrhosis or liver cancer. Because most people do not have symptoms during the early stage of the disease, hepatitis C is usually diagnosed after many years when its damage may be advanced. Because both viruses are transmitted by blood, many people infected with HIV are also infected with hepatitis.

Because they are caused by different types of viruses, hepatitis B and hepatitis C are treated differently, however both are diagnosed by blood tests—we use both serologies and viral load testing.

Videos: What is Hepatitis B and C?

Dr. Robert Brown – What is hepatitis B?

Dr. Robert Brown – How is hepatitis B diagnosed?

Dr. Robert Brown – How is hepatitis B treated?

Dr. Robert Brown – What is hepatitis C (HCV)?

Dr. Robert Brown – How is hepatitis C (HCV) diagnosed?

Dr. Robert Brown – How is hepatitis C (HCV) treated?

Progression of Disease

Each patient's liver disease develops differently. This means that there is no one pattern of symptoms to anticipate. As the disease progresses, eventually the liver may be unable to perform its many functions adequately. Patients may develop any of the following symptoms:

  • Fatigue
  • Sleep reversal (inability to sleep at night but wanting to sleep all day)
  • Forgetfulness or mental confusion
  • Loss of consciousness (coma)
  • Ascites (fluid in the abdomen)
  • Spontaneous bacterial peritonitis (infection of the ascites)
  • Edema (swelling of the legs)
  • Bleeding gums
  • Vomiting of blood
  • Bleeding from rectum or passing black stools (from internal bleeding)
  • Itching of the skin
  • Enlarged breasts in male patients
  • Jaundice or "liver spots" (spider angiomata, and petechiae)

Treatment of Hepatitis B and C

Hepatitis B Treatment Options

Treatment for the hepatitis B virus (HBV) includes antiviral or immunomodulatory therapy with nucleosides, nucleotides, and interferon-alpha. Currently first-line FDA approved therapies include tenofovir, entecavir, and pegylated interferon.

Hepatitis C Treatment Options

PEGylated Interferon with ribavirin has long been the standard treatment strategy for hepatitis C virus (HCV), however interferon had a suboptimal cure (or SVR) rate and significant side effects. These can include lower blood count of both white blood cells and platelets, altered thyroid function, flu-like symptoms, depression, and fatigue. As a result, the therapy is difficult for some patients, and not recommended for others. Ribavirin's side effects include hemolysis (breaking down of red blood cells), which can make the medication unsuitable for patients with anemia, heart disease, or renal problems.

Over the last ten years, newer classes of drugs that work directly on the HCV virus called Direct Acting Antivirals (DAA’s) have been studied and found to be more effective. These drugs come in several classes including protease inhibitors, nucleotide and non-nucleotide polymerase inhibitors and NS5A inhibitors. These drugs have increased the cure rate and decreased the side effects by shortening the course of therapy required and, in many cases, eliminating the need for interferon and ribavirin. The Center has been involved many of the studies of these new drugs over many years, and our patients have the opportunity to participate in clinical trials of the newest and most promising drug regimens. We are proud to have helped bring many of these promising new drug developments into the clinical arena.

Regardless of your prior medical problems, it is important that you seek medical advice to help decide which treatment regimen is best for you.

Viral Hepatitis Patient Support Groups

Hepatitis B Patient Support Group
First Thursday of Each Month
Click to learn more.