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Hepatitis: What Is It?

Summer 1999

Hepatitis is the term used to describe a nonspecific inflammation of the liver. The causes of hepatitis can be many, such as viral, parasitic, infiltrative, drug or alcohol induced, or non-specific. The initial clinical presentation of the acute phase of hepatitis may range from asymptomatic (without any noticeable signs) to severe fatigue, jaundice (yellow looking eyes or skin), nausea, vomiting, or diarrhea.

All patients whose laboratory values are monitored will have increases in their liver enzymes. This article will provide information about the pathophysiology, specific causes and treatments that are available both commercially or in current clinical trials for viral hepatitis A, B, and C, and drug/alcohol induced hepatitis.


So what is the liver and what does it do?

The liver is located in the right upper section of your abdomen, underneath your ribs. When the liver is enlarged (hepatomeglia) it can protrude below the rib cage and be tender to touch. The liver plays an important role as a detoxifier, by processing potentially harmful agents into chemicals that are safe for the body. The liver is also responsible for glucose metabolism, which is a source for energy, that our cells need (including the brain) to sustain life. Another function of the liver is to help control a portion of the pathway to allow our blood to clot when it needs to. The liver is considered to be part of the digestive system and controls the secretion of bile, an important enzyme that breaks down fats and starches from the foods that we eat.

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What is hepatitis?

Hepatitis is a non-specific term that is used to describe an inflammation of the liver. It can be diagnosed after blood is obtained and shows an elevation in liver enzymes (also referred to as ALT and AST). Normal values for liver enzymes may vary from laboratory to laboratory.


Hepatitis A

Hepatitis A (HAV) is transmitted through oral-fecal contact. Acute HAV usually has an acute phase that lasts from 4-6 weeks with or without jaundice, fatigue and hepatomeglia. During this acute phase, individuals with a co-infection of human deficiency syndrome (HIV) may have a considerable drop in T-cell counts that will rebound in 6-12 weeks after acute infection. HAV is generally cleared from the body after 6 weeks. It may take months to recover from acute HAV.

Treatment for HAV is usually supportive care with rest, discontinuation of drug therapy until the acute phase is completed, at which time therapies may be restarted. Drinking plenty of water, bed rest and good nutrition are all essential for a complete recovery.

During the last year, a vaccination for HAV has become available and can be considered as preventive therapy in those patients with chronic terminal infections such as HIV infection. This may prevent potential infections for those individuals who may be immuno-compromised. Some insurance companies, health care facilities or studies may offer the vaccination free of cost to patients. Check with your health care provider.


Hepatitis B

Hepatitis B virus (HBV) infection remains a considerable health problem worldwide and a significant cause of liver disease and liver cancer in humans. HBV is readily transmitted via parenteral (sharing needles or a blood transfusion) and sexual routes, and as such, it commonly found in individuals who are coinfected with HIV. For the patient with HIV infection, a frequent outcome of HBV is becoming a chronic carrier. Chronic HBV occurs after an acute infection. Approximately 20% of the patients are unable to clear the virus. The infection may continue to develop an enlarged liver, liver failure and/or primary liver cancer.

Certain population groups are considered to be at high risk of HBV infection, including Native Alaskans, Pacific Islanders and infants born to women who are first generation immigrants from regions where HBV is very common. The risk for acquiring HBV through sexual contact is highest among homosexual men, those with multiple sexual partners and years of sexual activity. Unprotected heterosexual contact has also been linked to HBV transmission.

All blood and body fluids are considered to be potentially infectious. In infected patients, HBV particles have been found in saliva, semen and cervical secretions. Common modes of transmission include: accidental puncture of the skin with an infected needle, blood splashed in the eye or sharing of un-sterilized needles. Other modes include exposure to instruments while receiving tattoos, ear piercing or acupuncture as well as sharing razors or toothbrushes. It is believed that insects may also serve as vectors by either biting or contaminating food.

Hepatitis B can be found in any age group. The normal incubation period is 28 - 160 days. Patients may present with insidious symptoms such as, joint pain, rash, nausea, vomiting and less commonly jaundice.

Suppressive therapy for HBV becomes extremely important to prevent progression to cirrhosis, deterioration of the liver, liver cancer. Little data is available about HIV-infected patients with chronic HBV.

Data from several studies suggests that 3TC (Epivir) shows promise as an effective treatment for chronic HBV. Most of the data that is available addressing chronic HBV response with 3TC has been done in HIV negative patients. Little data is available in patients who are co-infected with human immunodeficiency virus (HIV) and chronic HBV.

Several reports have found early resistance to 3TC in non-HIV infected patients. Data from a study done on immunocompromised adults with chronic HBV showed a high incident of 3TC resistance. This may have implications for the concept of long-term virus-suppressive therapy of chronic HBV using 3TC monotherapy. Adefovir has shown activity against HBV in clinical trials.


Hepatitis C

Little data is available about hepatitis C. It has only been in the last several years that we could test for the presence of HCV through the use of PCR RNA testing. Many patients do not have the antibodies present to test positive on a HCV antibody testing and must be diagnosed by PCR. The route of transmission is still unclear. Several researchers believe it may be transmitted through blood exposure during recreational drug use. A co-infection in an HIV-infected patient with both HCV and HBV increases illness and/or death.

Several studies have evaluated the use of alpha interferon subcutaneously without a significant improvement in the patients disease status. However, a new clinical trial using alpha interferon and ribaviron is showing promise, but the results are still not known.


Conclusion

Hepatitis can be a direct result of taking drugs that may be required to treat another illness. Prompt evaluation of an increase in liver enzymes can lead to a diagnosis. Once diagnosed, further evaluation, discontinuation of the offending drug and close follow-up can be conducted.

Prevention is still the best intervention. Condom use during sexual encounters will help to decrease the risk of hepatitis B and has been shown to be effective. Thorough handwashing is an important first line prevention to protect transmission of most viruses. Little information is available about other causes of hepatitis. Studies need to be done to evaluate effective treatment for those individuals who are already infected with chronic disease.


What should I do?

1) When you have sex use a condom (male or female should protect you).

2) Wash your hands frequently.

3) Have regular visits to you health care practitioner to discuss safe sex, symptoms of hepatitis and have regular check ups.


Nevens F, Main J, Honkoop P, Tyrrell DL, et al. Lamivudine therapy for chronic hepatitis B: A randomized dose-ranging study. Gastroenterology 1997; 113:1258-1253.

Rostaing, L Henry S, Cisterne J-M, Duffaut M, et al. Efficacy and safety of lamivudine on replication of recurrent hepatitis B after cadaveric renal transplantation. Transplantation. Vol. 64. No11, Dec.15, 1997.

Honkoop P, Niesters H. De Man R. , et al. Lamivudine resistance in immunocompetent chronic hepatitis B. Journal of Hepatology. '97; 26: 1393-1395.




  
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This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.
 
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