Hepatitis: An Overview
By Irene Cergnul, MD
Hepatitis is a general term originating from the Greek words hepa meaning liver and -titis meaning inflammation. Inflammation of the liver can be caused by a number of things including but not limited to chemicals, toxins, drugs, viruses and autoimmune mechanisms.
A doctor can detect hepatitis in a number of ways. First upon physical examination, usually by pressing fingers into the abdomen to feel for an enlarged liver. An x-ray or sonogram (ultrasound) can also show an enlarged or shrunken liver. Laboratory (blood) tests can detect hepatitis and are discussed in the article by James Learnerd. Unfortunately these tests cannot tell the doctor the cause of the hepatitis but only that the liver is enlarged or inflamed. Symptoms of hepatitis may vary depending on the cause. One general symptom is yellowing of the skin and eyes known as jaundice. This happens when bile, a substance produced by the liver, becomes backed up into the blood instead of being excreted into the gastrointestinal track. Other symptoms that are associated with viral causes of hepatitis are discussed later in this publication.
Because the liver is responsible for breaking down and clearing toxins from the blood, individuals exposed to toxic industrial chemicals or other toxins (certain mushrooms, plants and herbs) can develop chemical hepatitis. Recovery from chemical hepatitis depends on the amount and the length of exposure to a particular toxin. In many cases, if liver damage is not severe, the liver will regenerate (regrow) damaged cells.
Drugs, like chemical toxins, are cleared through the liver and can also cause hepatitis. Alcoholic hepatitis is the most common type of drug induced hepatitis. Overdosing (taking too much) of over the counter medications such as acetaminophen (Tylenol) can also cause hepatitis. Individuals with chronic illnesses who must take lots of medications can experience hepatitis and must be monitored by their doctor.
There are many viruses that can cause hepatitis these include A, B, C, D, E and G viruses. Other viruses are suspected to cause hepatitis but have not yet been named. Symptoms range from mild and inapparent to severe and sometimes fatal. Infections can be either chronic (long-term) or acute (short-term).
Hepatitis A virus (HEP A) is transmitted almost exclusively by the fecal-oral route, although gay men are at risk for sexual transmission. Travelers who visit countries without adequate sewage treatment facilities are susceptible to infection. Most infections result from contact with a household member or sex partner who has HEP A. Infection is more severe in children than adults and very rarely results in chronic infection. HEP A is rarely fatal and usually resolves within 4-6 weeks. A vaccine is available for HEP A.
Hepatitis B virus (HEP B) is transmitted by blood and blood products (including contaminated needles), sexual contact or from mother to child (vertically). A small percentage of individuals with acute HEP B infection will go on to have chronic infection and may develop cirrhosis or liver cancer. A vaccine is available for HEP B.
Hepatitis C virus (HEP C) is described in detail in the article "Co-infection with HIV and HEP C: Beyond the Basics."
Hepatitis Delta virus (HEP D) is a defective single-stranded RNA virus that requires the helper function of HEP B to replicate. HEP D virus can be acquired either as a co-infection with HEP B or as a superinfection of persons with chronic HEP B infection. Persons co-infected with both HEP B and HEP D may have more severe acute disease and a greater risk of liver damage compared with those infected with HEP B alone. For those co-infected, a greater precentage (70%-80%) go on to develop chronic liver diseases with cirrhosis as compared with those who are infected with HEP B alone (15%-30%). There is no vaccine for HEP D.
Hepatitis E virus is the major cause of entrically transmitted non-A, non-B hepatitis worldwide. It is transmitted primarily by the fecal-oral route such as fecally contaminated drinking water. Person to person transmission of HEP E appears to be uncommon. Virtually all cases of acute HEP E in the United States have been reported among travelers returning from high risk areas. Regions of the world which have high incidences of HEP E are primarily developing countries and include areas of Central America, Africa, Southeast Asia and India. When traveling to these regions of the world the best protection is to avoid drinking water (and beverages with ice) of unknown purity, eating uncooked shellfish, vegtables and unpeeled fruit. There is no vaccine for HEP E.
About This Issue
This issue of CRIA Update focuses on some of the most important concerns facing people who are co-infected with HIV and Hepatitis C. First, Irene Cergnul, MD, one of CRIAs study coordinators, offers a brief introduction to hepatitis discussing what it is and its many causes. Next, Douglas Dietreich, MD, renowned HEP C researcher, clinician and CRIA Board member, along with regular contributor Tim Horn, explore the complexities of HIV/HEP C co-infection. James Learned of Hepatitis-C Action and Advocacy Coalition (HAAC) in New York, discusses some of the ways in which HEP C is diagnosed and monitored throughout the course of disease.
To help readers understand what the treatment landscape looks like -- both now and in the near future -- Tim Horn has summarized much of what is known about interferon therapy, the new antiviral ribavirin, and some of the novel therapeutics in development. Finally, CRIAs Managing Editor, David Pieribone presents a common sense guide to liver health. We hope that the information in this issue, along with regular health care, will allow individuals who are co-infected with HIV and HEP C and their caregivers to better understand their disease and, with the help of their doctor, make the most appropriate treatments decisions.
J Daniel Stricker, Editor in Chief
CRIA co-sponsors monthly educational forums on AIDS research and treatment issues. Upcoming forums:
Wednesday, November 22 Wednesday, December 8 Wednesday, January 12 The forums are held at 7PM in the Cronin Auditorium, 10th Floor of St. Vincent's Hospital at 11th Street and 7th Avenue, Manhattan. Forum summaries are now available on CRIA's website: www.aidsinfonyc.org/cria.
Wednesday, November 22
Wednesday, December 8
Wednesday, January 12
The forums are held at 7PM in the Cronin Auditorium, 10th Floor of St. Vincent's Hospital at 11th Street and 7th Avenue, Manhattan. Forum summaries are now available on CRIA's website: www.aidsinfonyc.org/cria.