Q: After recovering from an attack of hepatitis last winter, I learned that some people develop a continuing viral infection of the liver. My husband has been pestering me to find out if the hepatitis is still present and, if so, what can be done about it.
A: In this country, hepatitis is usually caused by one of several hepatitis viruses, designated A, B and C. The type A virus infection results from drinking water or eating food, such as raw oysters, contaminated with the virus. Type A viral hepatitis does not cause a chronic infection of the liver. Either hepatitis B or C, on the other hand, can lead to chronic liver disease or a carrier state.
Persistance of hepatitis B or C in the body can be identified by a test that detects viral products or antibodies to the virus in the blood. Both viruses are transmitted by blood products mostly via contaminated needles used for intravenous injections of illicit drugs or inadvertent needle sticks by health care workers. Blood transfusions are also a source of infection, but only rarely now that infected blood can be detected by sensitive tests that screen all blood donors.
Hepatitis B virus (and rarely, C) can also be transmitted during sexual intercourse or to a newborn during childbirth. In carriers, the hepatitis B or C virus is present in the liver and blood and causes no ill effects, but can be given to others. In chronic hepatitis, patients have a general feeling of ill health; fatigue, especially "running out of gas late in the day"; decreased exercise tolerance; weakness; loss of appetite; joint aches and depression. Progressive damage from chronic hepatitis can cause cirrhosis, a replacement of liver cells with fibrous scar tissue. Those who develop cirrhosis from chronic viral hepatitis are at increased risk for liver cancer and liver failure. The later of which can only be treated effectively with a liver transplant, and because hepatitis B virus persists in other tissues, infection can recur even after a transplant.
The risk of developing a chronic infection with a hepatitis virus depends partly on the individual's age at the time of infection. JTC Hepatitis B infection in an adult carries a 10 percent to 15 percent risk of leading to chronic infection or the carrier state. The danger of a chronic infection is particularly high when newborns get the infection from their mother at the time of birth. Hepatitis B virus is transmitted from an infected mother in 10 percent to 20 percent of births, and as many as four out of five of such infected infants develop a chronic infection with the virus.
Because you have a history of a prior hepatitis infection, you should be tested for the continued presence of the virus if you become pregnant. In fact, it would be a good idea for all women to have a screening test for hepatitis B during pregnancy since they may have had hepatitis without even knowing it -- more than half of the people with an initial infection of viral hepatitis have no symptoms.
A series of injections of hepatitis B vaccine, beginning in the newborn period, can prevent them from developing chronic hepatitis or the carrier state. Hepatitis B vaccine is now also recommended for all children as well as doctors, nurses, laboratory workers and others who risk exposure to contaminated blood products. Currently, there is no vaccine against hepatitis C.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.