Viral Hepatitis >> DiagnosisHealth.com Dr. Minocha's Health Blog
Dr. Minocha is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies".
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|Viral hepatitis may be caused by a variety of viruses. Many of them are recognized by the English language alphabet in the order they were discovered.|
Hepatitis A Virus (HAV)
|HAV causes acute and not chronic hepatitis.
It is spread via contaminated food and water or person-to-person
contact. Other persons at risk include homosexual men and intravenous
drug users. Transmission via intravenous drug use is uncommon these
days. Incubation period is fifteen to 45 days before the symptoms
Patients may have nausea and vomiting with or without jaundice. Severity increases with age. Children rarely develop jaundice. Course is usually self-limited. Illness resolves in three to 6 weeks, but may persist for several months. Treatment is supportive.
Hepatitis B virus (HBV)
|Risk factors for HBV include intravenous
drug abuse, multiple or homosexual sex partners, tattooing, multiple
transfusions especially prior to 1986, medical personnel, patients on
hemodialysis and immigrants from endemic areas of Asia and Africa.
Incubation period is 30-150 days. Acute hepatitis may not manifest any
symptoms at all.
Treatment of choice is Interferon injections daily for 4-6 months. An alternate is lamivudine (Epivir) which is given by mouth for a year.
Hepatitis B is a preventable disease. Passive immunization (HBIG) is recommended when a person is stuck by a used needle that has been exposed to a HBV patient. In addition, active vaccination is also administered. HBIG is also given to new born babies of mothers infected with HBV.
Active HBV vaccine (Engerix-B and Recombivax HB) is recommended for high risk groups like medical personnel, intravenous drug users, and infants of infected mothers. An initial dose is followed by a booster dose at one and six months.
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Hepatitis C Virus (HCV)
common form of chronic hepatitis in the U.S. is caused by HCV. Risk
factors for acquiring infection include intravenous drug use, multiple
blood transfusions and health care personnel in contact with patients.
Transmission through sexual intercourse is uncommon (less than 5
percent). An infected pregnant mother may pass the virus on to the
infant in three to 6 percent cases.
Hepatitis C can be diagnosed by testing blood for antibodies against the virus, or even the virus itself. Assessment of the damage to the liver however, requires a liver biopsy.
Treatment is generally not recommended for patients whose liver is minimally affected by the HCV and do not have any active inflammation or fibrosis in the liver. Patients with advanced cirrhosis, active alcoholism or intravenous drug abuse are not good candidates for treatment. Treatment of patients with HIV needs to be individualized.
We used to treat patients with alpha-interferon for 6 months. The present trend is to treat for at least 12 months. Side-effects include reduction in blood cell as well as platelet counts, and depression. Despite this very costly and sometimes toxic therapy, the virus can be eradicated only in a small fraction of patients.
Pegylated (long acting) interferons promise to improve compliance and increase eradication rates.
These days, the treatment of choice involves using a combination of alfa-interferon and ribavirin for twenty four to 48 weeks. The combination is marketed as Rebeteron. In contrast to interferon alone, this combination treatment can eradicate the virus in about 38 percent patients.
Ribavirin can be very toxic in as many as a quarter to one-third of
patients. The most common serious side-effect involves breaking down of blood cells causing anemia, which can necessitate cessation of treatment in some cases.
Rebeteron also has very serious toxic-effects on the fetus. Thus, it must not only be not used by women who are pregnant or planning to be pregnant, but also not by men whose sexual partners are pregnant or planning to be pregnant.
HCV is the most common indication for liver transplantation (30-40%) in the U.S.. Recurrence of HCV occurs in nearly all cases after transplantation, but infection is usually mild.
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Anil Minocha M.D.; FACP; FACG
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