Q: What is hepatitis? What is the difference between hepatitis B and C?

A: Hepatitis is an inflammation of the liver. Hepatitis can occur due to various reasons including infections, alcohol, medications, environmental exposures and autoimmune diseases. Of these, the most common is infection with hepatitis viruses such as Hepatitis A, B and C. Hepatitis can be caused by certain viruses of which the Hepatitis A, B and C viruses are the most common. Hepatitis B (HBV) and Hepatitis C (HCV) are transmitted by blood and certain bodily fluids whereas Hepatitis A (HAV) is spread by ingesting contaminated food or close personal contact.

Q:What causes hepatitis B and C?

A:HBV and HCV are both transmitted when blood or certain bodily fluids from an infected person enters another person's body. These include sharing needles among drug users, needle sticks on the job (health care) and at times from an infected mother to her baby. Although both viruses can be transmitted through unprotected sex with an infected individual, it is far less common with HCV.

Q:What are the symptoms?

A: Most common symptoms of hepatitis are non specific and may include tiredness, lethargy, decreased appetite, abdominal pain, nausea, muscle aches and low grade fevers. Patients may also develop jaundice (yellowing of the skin and eyes). People infected with HCV may have no symptoms at all for many years and diagnosis is usually made incidentally with blood work. If the disease progresses to liver failure or cirrhosis, symptoms can include abdominal distention with fluid and confusion.

Q: How are hepatitis B and C treated?

A:In a majority of the patients with Hepatitis B infection, the body's immune system is able to fight off and suppress the virus within six months. In patients who continue to have the infection, the treatment consists of long-term antiviral medications. Hepatitis C virus leads to a more persistent infection in the majority of the infected individuals. The treatment for this persistent or chronic infection is also with antiviral therapy. This therapy is comprised of medications known as interferon, ribavirin and more recently, protease inhibitors. A combination of these medications is given for a number of months depending on the response to treatment. In the event that cirrhosis or liver failure develops, the patient may be referred for liver transplantation. Apart from antiviral therapy, guidance has to be provided to patients for proper vaccination, alcohol abstinence, avoidance of medications that may be harmful to the liver, screening for liver cancer and proper diet and exercise.

Q:What is the prognosis for people with hepatitis?

A:The majority of the people infected with Hepatitis B virus are able to clear themselves of the infection without any treatment. The ones who do get started on treatment for persistent infection are able to successfully control the infection with excellent prognosis. A small percentage may still go on to develop cirrhosis of the liver or liver cancer. Hepatitis C infection may progress to liver cirrhosis in approximately 25 percent of patients. Treatment with antiviral medications is initiated to prevent this progression. The response to HCV treatment depends on the strain (genotype) of the virus. The most common in the United States is genotype 1 and cure rates with the newer medications approach 70 to 80 percent.

Q:How can we prevent the spread of hepatitis?

A:The spread of hepatitis is preventable. Hepatitis A which is spread by contaminated food can be prevented by good hand hygiene (proper and frequent hand washing) and safe food preparation practices. Hepatitis B and C can be prevented by avoiding sharing razors or tooth brushes, covering open sores and cuts, avoid donating blood, organs or sperm and cleaning up any blood spills with bleach and water. Hepatitis B can also be spread by sexual contact, and safe sex practices, including use of condoms is highly recommended. Hepatitis C, however, has a very low rate of transmission through sexual contact especially among monogamous partners. For both Hepatitis B and C, casual contact including hugging, kissing, sharing eating utensils or cups, sharing food and water, hugging, kissing, coughing and sneezing do not increase the risk of transmission.

Q: How widespread are hepatitis B and C?

A:Hepatitis B and C are fairly common in the U.S. The Center of Disease Control has reported 43,000 new cases of Hepatitis B in the U.S. in 2007 and approximately 1.2 million people with chronic Hepatitis B infection. For Hepatitis C, there were 17,000 new infections diagnosed in 2007 and approximately 3.2 million people with chronic Hepatitis C infection.

Ayaz Matin, M.D. is a board-certified gastroenterologist (GI) specializing in diseases of the digestive system with St. Luke's Health Network.