Hepatitis

What Is Hepatitis?

Hepatitis refers to inflammation of the liver. While it can be caused by alcohol use, toxins, medications, and autoimmune conditions, viral hepatitis is the most common form worldwide. The five main types of viral hepatitis are caused by the hepatitis A, B, C, D, and E viruses. Of these, hepatitis A, B, and C are the most prevalent in the United States and are the primary focus of gastroenterology evaluation and management.

The liver performs over 500 essential functions including filtering blood, producing bile for digestion, metabolizing nutrients and medications, storing vitamins and minerals, and producing proteins essential for blood clotting. When the liver becomes inflamed, these critical functions can be impaired, leading to a wide range of health consequences.

Types of Viral Hepatitis

Hepatitis A (HAV)

Hepatitis A is a highly contagious but typically short-term (acute) liver infection. It is transmitted through the fecal-oral route — ingesting food or water contaminated with the virus or through close contact with an infected person. Hepatitis A does not cause chronic liver disease and most people recover fully within a few weeks to months. An effective vaccine is available and recommended for all children and at-risk adults.

Hepatitis B (HBV)

Hepatitis B is a potentially serious liver infection transmitted through blood, semen, and other body fluids. It can be acute or chronic. While most adults who contract hepatitis B recover fully, approximately 5 to 10% develop chronic infection. Infants and young children have a much higher risk of chronic infection (up to 90% if infected at birth). Chronic hepatitis B can lead to cirrhosis, liver failure, and hepatocellular carcinoma (liver cancer). An effective vaccine is available.

Hepatitis C (HCV)

Hepatitis C is a blood-borne viral infection that primarily affects the liver. It is most commonly transmitted through sharing needles or other equipment for injecting drugs, though it can also be transmitted through blood transfusions (prior to 1992), needlestick injuries, and rarely through sexual contact or from mother to child during birth. Approximately 75 to 85% of people infected with hepatitis C develop chronic infection. The major advancement in hepatitis C treatment is that it is now curable in over 95% of cases with direct-acting antiviral medications.

Common Symptoms

Many people with viral hepatitis — particularly chronic hepatitis B and C — may have no symptoms for years or even decades. When symptoms do appear, they may include:

Jaundice: Yellowing of the skin and whites of the eyes
Fatigue: Persistent, often profound tiredness
Abdominal pain: Particularly in the upper right quadrant where the liver is located
Dark-colored urine
Pale or clay-colored stools
Nausea, vomiting, and loss of appetite
Low-grade fever
Joint pain
Itchy skin (pruritus)

In cases of advanced liver disease or cirrhosis, additional symptoms may include:

Ascites: Fluid accumulation in the abdomen
Easy bruising and bleeding
Spider angiomas: Small, spider-like blood vessels visible on the skin
Confusion or difficulty concentrating (hepatic encephalopathy)
Swelling in the legs (edema)

Causes and Risk Factors

Risk factors vary by hepatitis type:

Hepatitis A: Travel to areas with high HAV prevalence, men who have sex with men, use of recreational drugs, homelessness, close contact with an infected person
Hepatitis B: Birth to an HBV-positive mother, unvaccinated healthcare workers, sexual contact with an infected person, sharing needles, travel to endemic regions (Asia, Africa, Pacific Islands), household contact with a chronically infected person
Hepatitis C: Current or past injection drug use (the most common risk factor), receiving a blood transfusion or organ transplant before 1992, long-term hemodialysis, HIV infection, birth to an HCV-positive mother, incarceration, intranasal drug use, unregulated tattoos or piercings

The CDC recommends universal hepatitis C screening for all adults aged 18 and older at least once in their lifetime, and hepatitis B screening for all adults at least once.

Diagnosis

Dr. Khan uses a comprehensive diagnostic approach for hepatitis evaluation:

Hepatitis A testing: IgM anti-HAV (indicates acute infection); IgG anti-HAV (indicates past infection or vaccination/immunity)
Hepatitis B panel: HBsAg (surface antigen — indicates active infection); anti-HBs (surface antibody — indicates immunity); anti-HBc (core antibody — indicates past or current infection); HBeAg and HBV DNA viral load (assess viral replication and disease activity)
Hepatitis C testing: Anti-HCV antibody (screening test); HCV RNA viral load (confirms active infection); HCV genotype (guides treatment selection)
Liver function tests: ALT, AST, alkaline phosphatase, bilirubin, albumin, and INR to assess liver inflammation and function
FibroScan (transient elastography): A non-invasive test that measures liver stiffness to assess the degree of fibrosis (scarring) without the need for a liver biopsy
Liver biopsy: Occasionally needed to determine the extent of liver damage when non-invasive tests are inconclusive
Imaging: Ultrasound, CT, or MRI to evaluate liver size, detect masses, and screen for hepatocellular carcinoma in chronic hepatitis B patients

Treatment Options

Hepatitis A Treatment

There is no specific antiviral treatment for hepatitis A. Management is supportive, focusing on rest, adequate hydration, nutrition, and avoiding alcohol and hepatotoxic medications. Most patients recover completely within 2 to 6 months. Prevention through vaccination is the most effective strategy.

Hepatitis B Treatment

Acute hepatitis B: Usually resolves on its own in adults; supportive care is the mainstay
Chronic hepatitis B: Not all patients require immediate treatment. Dr. Khan monitors viral load, liver enzymes, and fibrosis stage to determine when treatment is indicated. Antiviral medications include:
- Entecavir or tenofovir (preferred first-line nucleos(t)ide analogues) — taken orally, often long-term
- Pegylated interferon-alpha — a finite course of injections that may achieve HBsAg loss in select patients
Hepatocellular carcinoma surveillance: Patients with chronic hepatitis B require regular liver ultrasound and AFP (alpha-fetoprotein) testing every 6 months to screen for liver cancer

Hepatitis C Treatment

Hepatitis C is now curable. Direct-acting antiviral (DAA) medications achieve sustained virologic response (cure) in over 95% of patients, typically with 8 to 12 weeks of oral therapy. Current treatment regimens include:

Sofosbuvir/velpatasvir (Epclusa): A pangenotypic regimen effective against all HCV genotypes
Glecaprevir/pibrentasvir (Mavyret): Another pangenotypic option, often used as an 8-week course for treatment-naive patients
Sofosbuvir/ledipasvir (Harvoni): Effective for genotype 1, the most common genotype in the United States

These medications have minimal side effects compared to older interferon-based treatments and are well-tolerated by most patients, including those with compensated cirrhosis.

When to See a Doctor

You should consult a gastroenterologist or hepatologist if you:

Have risk factors for hepatitis B or C and have never been tested
Received a positive hepatitis B or C screening result
Experience unexplained jaundice, fatigue, or abdominal pain
Have elevated liver enzymes found on routine blood work
Were born between 1945 and 1965 (the "baby boomer" generation has a higher prevalence of hepatitis C)
Have a history of injection drug use, even if only once
Were born to a mother with hepatitis B or C
Are living with chronic hepatitis and need ongoing monitoring or treatment evaluation

Dr. Amber Khan at GastroCares provides comprehensive hepatitis screening, diagnosis, treatment, and long-term liver health management. With modern antiviral therapies, hepatitis C can be cured, and chronic hepatitis B can be effectively controlled to prevent liver damage and its complications.