What is hepatitis?
Hepatitis C Facts
1.0.1 What is hepatitis?
Hepatitis is an inflammation of the liver. It is a symptom a many different diseases and conditions. Poisons, viruses, bacteria, parasites, auto-immune disorders, and drugs can all cause hepatitis.
Hepatitis A, B, and C are all forms of viral hepatitis. Although their names sound the same, they are actually very different viruses, causing different symptoms and require different treatments. Other viruses that cause hepatitis are hepatitis D, E, and G; these are less common, and were discovered more recently than hepatitis A, B and C.
Non-viral hepatitis can be caused by toxic agents or autoimmune disease. Autoimmune disease is the body attacking itself, treating its own tissues like foreign invaders. Toxic hepatitis is a deterioration of the liver cells caused by chemicals, alcohol, drugs, or industrial compounds. Toxic hepatitis is another way of saying liver inflammation due to poisoning.
Alcohol abuse is one of the most common causes of toxic liver damage.
1.0.2 What are the different types of hepatitis?
The different types of VIRAL hepatitis are:
- A (formerly called infectious hepatitis, or yellow jaundice)
- B (serum hepatitis)
- C (formerly called non-A, non-B hepatitis)
- D (delta hepatitis)
- E (transmitted through the feces of an infected person)
- G (a virus transmitted through infected blood products)
- CRYPTOGENIC (or Non-A,B,C,D,E,G)
More hepatitis viruses are being discovered, but may be less common. Other viruses, such as Yellow Fever, Epstein-Barre virus, Cytomegalovirus, as well as parasites and bacteria, can cause hepatitis as a secondary effect.
Types of NON-VIRAL hepatitis are:
- Autoimmune disease (the body attacking its own tissues)
- Wilson’s disease (a genetic disorder causing too much copper in the liver or brain)
- Hemochromatosis (a genetic disorder causing too much iron in the bloodstream)
- Drug, chemical, or alcohol induced hepatitis.
1.0.3 What happens in the body?
Different hepatitis infections enter the body in different ways. The hepatitis A and E viruses enter through the gut, whereas B, C, D, and G enter through the bloodstream. All forms of viral hepatitis attack the liver, and reproduce in the liver cells.
Hepatitis A and E thrive in unsanitary conditions. There is a vaccine for hepatitis A. It usually resolves itself, but can be fatal in children, the elderly, or the chronically ill. Hepatitis A can prove fatal to people with hepatitis C. Hepatitis E is found mainly in the third world. It also resolves itself, but it can pose a serious danger to pregnant women.
As hepatitis B, C, D, and G infect liver cells, the body attacks them, which causes the liver to become inflamed. With hepatitis B, the liver usually repairs itself, leaving behind antibodies. Antibodies are proteins produced by the body as a part of its defense against viruses. If you have only the antibodies for a disease it means that you either have it now, or you had it at one time and got over it.
Recent studies show that hepatitis B may resurface many years later in individuals who have supposedly cleared the virus, much like the “post-polio syndrome.” Up to 90% of those infected with hepatitis B will clear the virus. There is a vaccine for hepatitis B. There is no vaccine for hepatitis C. In most people who get hepatitis C the immune system doesn’t defeat the virus. More often than not, the antibodies fail to identify the hepatitis C virus properly. The infection remains long-term. Most infected people don’t know they have it. This is because for some people there will be no symptoms and for others, symptoms could take 13 years to develop. Some people have hepatitis C for over 20 years before they find out they have it. Hepatitis C affects different people different ways.
From what we know, if 100 people catch hepatitis C:
- 15-20 will have an acute infection. These people will get over the virus the same way a person gets over flu.
- 80-85 will get a chronic infection. This infection doesn’t go away without treatment.
Of those people with chronic infections:
- 60 will never show any more than a moderate level of liver damage, if they show any at all.
- 20-25 will progress to serious liver disease.
Of those who progress to serious liver disease:
- 10-will remain stable
- 15 will progress to liver failure or liver cancer after another 5 years According to an article in Gut 2000; 47:131-136, the 5 year rate for progression to hepatocellular cancer is 13.4% and the 5 year rate for progression to death is 15.3%.
Hepatitis C infection doesn’t always make people sick. When someone does get sick, symptoms take a long time to develop (approximately 13 years). Even when a person is showing symptoms, the pattern changes so much from person to person, the condition may be mistaken for something else. People often don’t get tested until they are showing symptoms of end-stage liver disease. It is important to get tested if you have any reason to believe that you ever had blood-to-blood contact with another person. Everyone should take precautions to prevent the spread of hepatitis C, even people who think they don’t have it.
Studies that follow the progress of the disease are few, include relatively few subjects, and only follow people over a short period of time. Generally, they only track those people whose date of infection can be well documented, (e.g., blood transfusion recipients and victims of accidental needle sticks). The progress of the disease appears to differ according to geography, alcohol use, virus characteristics, (e.g., genotype, viral load), co-infection with other viruses, age, age at infection, gender, weight, and other unexplained factors. - National Institutes of Health Statement on Hepatitis C 1997 and Gut 2004; 53:451-455
1.0.4 What is the incubation period?
The amount of time it takes for symptoms to appear varies between the different types of hepatitis. People with hepatitis A and E may start to develop symptoms as soon as 2 weeks after exposure, but it usually takes four weeks for symptoms to be noticeable. For hepatitis B and C it tends to take much longer. The average for hepatitis B is 2-3 months. In experiments on chimpanzees, hepatitis D developed two to ten weeks after infection.
1-3 weeks after the initial exposure, HCV RNA can be detected in blood. Virtually all patients develop liver cell injury within 15-150 days (50 days is the average). They check the level of liver damage by looking for an elevation of serum alanine aminotransferase (ALT—an enzyme which leaks out of the damaged cells into the bloodstream). The majority of patients is asymptomatic (doesn’t show symptoms) and anicteric (whites of the eyes are clear).
Only 25-35 percent develops discomfort, weakness, or anorexia, and some develop jaundice in the whites of their eyes. Rapid onset liver failure following HCV infection has been reported but is a rare occurrence.
Antibodies to HCV (anti-HCV) almost invariably become detectable during the course of illness. HCV antibodies can be detected in 50-70 percent of patients at the onset of symptoms and in approximately 90 percent of patients in 3 months after onset of infection.
When a disease goes away without treatment it is called self-limited; HCV is self-limited in 15% of cases. Recovery is characterized by disappearance of HCV RNA from blood and return of liver enzymes to normal. - National Institutes of Health Statement on Hepatitis C 1997.
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