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What is hepatitis? Dangerous infections a worldwide health threat

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Together, hepatitis B and C represent one of the major threats to global health. Hepatitis B and C are both 'silent' viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis).

If you have liver cirrhosis, you have a risk of life-threatening complications, such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you've developed cirrhosis.

In some cases, a diagnosis is made too late and the only option is a liver transplant. If you think you've been at risk, it's important to get tested as soon as possible and consider your treatment options and self-management strategies.

Patients with hepatitis B infection can also be infected with a second virus known as hepatitis delta virus, hepatitis D virus or simply HDV. (Find out more about hepatitis D at hepatitis-delta.org)

THE DIFFERENCE BETWEEN HEPATITIS B AND C

1. While there is a vaccine that protects against hepatitis B infection, there's no vaccine available for hepatitis C

2. Both viruses can be contracted though blood-to-blood contact

3. Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid

4. In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C

5. While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing

6. Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C

7. Even if treatment is not an option for you, you can do something about your disease. A healthy lifestyle is important. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen your liver disease. Therefore, try to avoid all alcohol, stop smoking, eat a low fat diet with enough fruit and vegetables, and reduce your weight if necessary

HEPATITIS B

The World Health Organization recognizes that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. An estimated 500,000 to 700,000 people die every year from hepatitis B.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of 10 adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

1. Flu-like symptoms

2. Fatigue

3. Nausea

4. Jaundice (yellowing of the skin)

5. Stomach ache

6. Diarrhea/dark urine/bright stools

7. Aching joints

Unlike hepatitis C, there is a vaccine that can prevent infection. If you think you're at risk, you should get vaccinated as soon as possible.

HEPATITIS C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15-30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, like hepatitis B, there are often no symptoms. Symptoms that do occur can include:

1. Flu-like symptoms

2. Fatigue

3. Nausea

4. Aching muscles and joints

5. Anxiety and depression

6. Poor concentration

7. Stomach ache

8. Loss of appetite

9. Dark urine/bright stools

PREVENTION

The hepatitis B virus (HBV) is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. Please note that it's very unlikely it can be contracted through kissing or sharing cutlery. The hepatitis C virus (HCV) is spread through direct contact with infected blood. Very rarely it may be passed on through other body fluids.

Most common routes of transmission for hepatitis B or C viruses include:

1. Blood transfusions and blood products using unscreened blood (in most countries, but not all, blood has been screened since about 1990)

2. Medical or dental interventions without adequate sterilization of equipment

3. Mother to infant during childbirth

4. Sharing equipment for injecting drugs

5. Sharing straws, notes etc. for snorting cocaine

6. Sharing razors, toothbrushes or other household articles

7. Tattooing and body piercing if done using unsterilized equipment

In the case of hepatitis B, infection can also occur through having unprotected sex with an infected person. If you think you could have been at risk from either hepatitis B or C, it's important to get tested.

Getting immunized is the best way of preventing hepatitis B infection. More than one billion doses of the hepatitis B vaccine have been used since the early 1980s and it has been shown to be effective in approximately 95 percent of cases. There's currently no vaccine for hepatitis C.

TESTING AND DIAGNOSIS

To diagnose hepatitis B the blood needs to be checked for the HB surface antigen (HBsAg). The HBs antigen is a part of the virus and will usually appear in your blood six to twelve weeks after infection. If the test is positive, you have hepatitis B. In that case, your doctor should conduct further tests to check if your hepatitis B infection is new or old, if it is harming your body or not, and if you need treatment or not.

If you've naturally cleared the virus, or if you've been vaccinated against hepatitis B, you will have antibodies to hepatitis B (anti-HBs). Your body made these to destroy the virus. It's good to have anti-HBs, because that means you're protected against future infection by the hepatitis B virus.

For hepatitis C, your doctor will first check for HCV antibodies (anti-HCV). If the test is positive, this means you either have the virus now, or have had the virus and cleared it. Hepatitis C antibodies usually take 7-9 weeks to appear in your blood after infection.

If your immune system is weakened (e.g. by HIV) your body may take longer to produce HCV antibodies, or it may not produce any at all. If the first test is positive, your doctor will then test for the virus itself (HCV RNA). If this is positive, you have hepatitis C.

If you are diagnosed with hepatitis B or C, you'll face many challenges, but it's better to confront the disease head on, know how to avoid transmitting the infection to others and consider your treatment options and self-management strategies as early as possible.

For further information about whether you might be, or have been, at risk and how you can get tested, please contact your local patient group, who will be able to provide you with the information that you need.

HEPATITIS B TREATMENT

Acute hepatitis B: It is not usually necessary to treat a new hepatitis B infection in the first six months. Nine out of ten new infections go away on their own, with or without treatment. In this early stage of disease, treatment makes very little difference to the chances of a cure. Antiviral drugs may only be necessary and helpful in rare cases, if the acute infection causes very aggressive liver inflammation.

Chronic (long-lasting) hepatitis B: consult with your doctor about your situation. Some people need treatment, while others should wait. Treatment does not usually cure you of hepatitis B, but it can turn an 'aggressive' hepatitis B infection into a mild infection. This can stop the liver from being damaged. If the infection is considered mild, it might be better to monitor it and wait until later for treatment. You can treat chronic hepatitis B with peg-interferon or with pills, which are called nucleoside or nucleotide analogues.

Peg-interferon alfa comes in a syringe and stimulates the immune system against the virus. This treatment may have side effects, such as fatigue, flu-like symptoms, depression, skin and hair problems and changes in blood chemistry, amongst others.

Treatment continues for 24-48 weeks and while not all hepatitis B patients respond well to interferon, certain types of hepatitis B infection do. For example, patients with genotype A, HBeAg positive, with elevated liver enzymes but NO cirrhosis can often successfully reduce their viral infection to a milder state.

Your doctor needs to monitor your interferon treatment closely. Interferon treatment should not be used if you already have cirrhosis of the liver.

Nucleoside and nucleotide analogues come in pills. They stop the virus from replicating. The pills have very few side effects, and even patients with cirrhosis can take them. However, patients need to take their pills every day for several years, sometimes a lifetime.

If the virus becomes resistant to one type of pill, it might stop working, and another, different drug will need to be added to their treatment to get the virus back under control. Your doctor should monitor your viral load (HBV DNA) to make sure your treatment works.

Don't forget to take your pills, even if you feel well. If you miss many doses or stop treatment too early, the disease might become worse than it was before.

HEPATITIS C TREATMENT

In many countries, the second quarter of 2011 marked the arrival of a new current standard of care for people with HCV genotype 1; Boceprevir (Victrelis) and Telaprevir (Incivek), which are protease inhibitors taken orally and added to the Pegylated interferon alfa and ribavirin combination treatment, have been launched in different countries given their significantly higher success rates.

Pegylated interferon alfa and ribavirin: This is still being used as first-line therapy choice for HCV patients with genotypes 2,3,4,5 and 6. It's also being used to treat HCV genotype 1 patients in countries where the new protease inhibitors have not been approved yet or where decisions on how to commission the drugs have not been taken yet.

Pegylated interferon alfa and ribavirin cures approximately half of all hepatitis C patients. A patient is considered to be cured if there's no virus in the blood six months after the end of treatment. This is different from hepatitis B therapy, which controls rather than cures the infection. Interferon comes in a syringe and ribavirin is available in pills.

The treatment may have side effects such as fatigue, flu-like symptoms, depression, hair and skin problems, and changes in blood chemistry. Therefore, treatment should be monitored by an experienced doctor or clinic. The duration of treatment is different from patient to patient. You usually need 24-48 weeks of treatment, but in some cases, 72 weeks may be recommended.

There are several subtypes of the hepatitis C virus, called genotypes. They don't seem to influence the course of the disease, but they respond differently to treatment. Patients infected with genotypes 1, 4, 5 and 6 are more difficult to cure than those infected with genotypes 2 and 3.

There are a number of new hepatitis C treatments in development.OURCE: World Hepatitis Alliance

(WhatDoctorsKnow is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at http://www.whatdoctorsknow.com.)

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Copyright © 2014, The Baltimore Sun
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