The ABC's of Hepatitis

I've decided to devote this month's column to the various forms of hepatitis because I get more and more questions about them from the participants of my safer sex workshops. And that's good, because in the midst of all our fears and frenzy about HIV, we often forget about some of the other sexually transmitted diseases.

There are five known versions of viral hepatitis, each named after letters of the alphabet. Hepatitis A, B and C are most common, while D and E are relatively rare. Viral hepatitis is a contagious disease that attacks the liver. Hepatitis can cause inflammation of the liver, usually producing swelling and tenderness and sometimes causing permanent damage or death. While some people show no symptoms, others experience fatigue, fever, muscle and joint aches, nausea, vomiting and changes in the color of urine or stool. Let's go over hepatitis A, B and C.

Hepatitis A: Caused by fecal contamination of food or water, or person to person fecal-oral contact. (By fecal, I mean the stuff that comes out of your butt, and fecal-oral contact refers to the practice known as rimming, where an individual places his/her mouth or tongue around the anal/rectal area of another individual.) Hepatitis A can occur suddenly and intensely, and people have been known to relapse. According to the American Liver Foundation it is rarely life-threatening and does not cause chronic hepatitis (infectious, lasting longer than six months). Nor do you become a carrier for life. Hepatitis A can be prevented by a vaccine (two shots spaced six months apart). It is found throughout the world and is especially common in developing countries with poor hygiene and sanitation. Most U.S. cases are person-to-person transmission, but you can get it from unsanitary water or ice, raw shellfish, or uncooked fruits and vegetables. And according to the Centers for Disease Control (CDC), there are between 125,000 and 250,000 cases in this country each year.

Hepatitis B: Caused by infected blood or body fluids and can be transmitted sexually or during birth. The hepatitis B virus is 100 times more contagious than HIV and it can cause liver failure, liver cancer, cirrhosis and death. Symptoms can include loss of appetite, fatigue, stomach cramps, vomiting and in some cases, the eyes and skin may turn yellow. Once infected with hepatitis B, there is no cure. However, hepatitis B can take two forms. The first form, acute hepatitis, lasts no longer than six months, after which you are no longer infectious. The other, chronic hepatitis, lasts longer than six months and you remain infectious. Hepatitis B is spread by sexual contact (rimming, sharing sex toys, anal or oral sex without a condom and possibly, but very rarely, through kissing or watersports), sharing razors, needles or toothbrushes, from mother to infant during birth and by unsterile tattooing or body piercing equipment. According to the American Liver Foundation, over 300,000 people are infected with the hepatitis B virus each year with an estimated one million carriers in the United States. Hepatitis B is more prevalent and infectious than HIV, with more than 70 percent of those infected being between the ages of 15 and 39. It's extremely important to be tested for hepatitis B, because testing can identify whether you are actually infected, recovering, a healthy carrier (infected without symptoms) or have chronic hepatitis. If you are sexually active, a health care worker, or travel abroad, I strongly encourage you to take the hepatitis B vaccine (it's a three shot series taken over a six month period).

Hepatitis C: Transmitted via blood or blood transfusions and can cause chronic liver disease, cirrhosis and liver cancer. Hepatitis C affects approximately 170,000 Americans each year and may develop into a chronic form in approximately 50% of patients (American Liver Foundation). Those particularly at risk are IV drug users, health care professionals exposed to needle sticks, and people who receive transfusions or hemodialysis. Hepatitis C tests, if positive, can indicate if you are currently infected or have been infected at some time in your life and may have recovered. A liver biopsy may be required to determine if you have chronic hepatitis C. In other words, tests are available to determine if you have a mild form of the disease or a more serious form. Unfortunately there is no vaccine currently available for hepatitis C, but new treatments are being developed (such as interferon). The American Liver Foundation reported last March that hepatitis C rates are climbing. However, CDC statistics show a decrease. Nevertheless, what remains true is that 85% of those who contract hepatitis C develop a chronic infection and up to 60% of them will later develop chronic liver disease.

A few other things to consider about hepatitis: although blood banks routinely screen all donated blood for these viruses, the potential for human error is involved and some tainted blood is overlooked. Consequently, a small percentage of people become infected with hepatitis (not to mention HIV) through blood transfusions.

As if that weren't scary enough, sometimes the vaccines don't take. While successful more than 95% of the time, these vaccines can be less effective in people living with HIV. In other words, they don't create antibodies to prevent disease, so you may think you're protected when in fact the vaccine failed. Vaccines can fail for a couple of reasons: a bad batch, not completing the series, or having a severely compromised immune system. Fortunately there are blood tests to determine if the vaccine worked or if you need a booster. And HIV+ individuals should also know vaccines can temporarily affect your viral load.

I recently found out my hepatitis B vaccine didn't take. My doctor discovered it while doing blood work to determine the source of my liver inflammation. (Note: I've been told several hepatitis B vaccines are available through different pharmaceutical companies; ask your physician if he/she prefers one over another.) Bottom line: I'll be taking the three-shot series over again because the last thing I want is a case of hepatitis to go along with my HIV; they are a deadly combination.