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ABCs of Hepatitis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Hepatitis, literally, inflammation of the liver, has many causes, including medications, excessive alcohol use and gall bladder or pancreas diseases. But for millions of Americans, hepatitis results from infection with a virus. In serious cases, and when chronic, hepatitis can lead to cirrhosis, liver cancer and eventually liver failure.

EMMET KEEFFE, MD: Viral hepatitis is complicated, because there are five different common viruses, but they're simply named by the alphabet. But really, there are three main viruses, hepatitis A, B and C.

ANNOUNCER: Infection with a hepatitis virus may have two phases: acute or chronic. In the acute phase, people often are ill with symptoms such as nausea, fever and vomiting, and they may become jaundiced. An acute infection usually goes away by itself over a short period of time. However, acute infections can develop into chronic infections, which are usually more serious. Chronic infections may last a lifetime and can result in cirrhosis, or scarring, of the liver, leading to cancer of the liver or liver failure.

EMMET KEEFFE, MD: Hepatitis A is still the most common cause of acute viral hepatitis, followed by B, and followed by a distant third by hepatitis C. We don't see very much acute hepatitis C. By contrast, when we have chronic viral hepatitis, hepatitis C is far more common.

ANNOUNCER: Hepatitis A is found in the stool of an infected person and is spread when a person eats food or drinks water that has been contaminated. In the US, outbreaks often occur when people don't wash their hands after using the bathroom and then prepare food.

EMMET KEEFFE, MD: Now, fortunately, we're a cleaner country that we were when I was born. I'm age 62 now, and I can tell you that people in my age generation, about 30 or 40 percent have an antibody to hepatitis A, which means that I was infected as a kid, even though I don't know that, but I have a protective antibody. If we look at 20- and 30-year-olds in the US, there's a much, much lower likelihood they have antibodies, because they've been raised in a much cleaner, more hygienic atmosphere than we had before.

ANNOUNCER: People most at risk for hepatitis A include international travelers, particularly to Southeast Asia and India; people living in areas where outbreaks are common; people who live with or have sex with an infected person; men who have sex with men; and injection drug users.

EMMET KEEFFE, MD: Fortunately, more than 99 percent of hepatitis A goes on to recovery. But one or two cases per 1,000, roughly, will go on to a severe course that will lead to death if there's not a liver transplant.

ANNOUNCER: Hepatitis B is transmitted through direct contact with the blood or body fluids of an infected person.

EMMET KEEFFE, MD: Most of hepatitis B is spread by sexual contact with an infected individual or by use of intravenous drugs. Fortunately, our blood supply now has been clean from hepatitis B. All blood donors are checked for hepatitis B. If that blood unit's positive, it's discarded. So blood now is only an extremely rare way that hepatitis B can be spread. Hepatitis B can also be spread by needle sticks, so physicians and nurses and other health care workers are at risk, but fortunately most health care workers now have become vaccinated to eliminate the risk for hepatitis B.

ANNOUNCER: Other modes of transmitting hepatitis B are tattoos and body piercing and the sharing of personal care products including toothbrushes or razors.

EMMET KEEFFE, MD: When you're infected with acute hepatitis B as an adult, there's a 95 to 98 percent chance the virus will go away. About one in 100, or maybe one in 300 in the case of acute hepatitis B, may progress to what we call fulminant, or severe, hepatitis B and need to be considered for liver transplantation and are at risk for sudden death. That, fortunately, is rare.

ANNOUNCER: Hepatitis C is a more recently discovered virus and is spread through contact with infected blood.

EMMET KEEFFE, MD: If you had blood transfusions before 1990, you're at risk that you have acquired hepatitis C. If you ever used IV drugs, even on a few occasions as a young college student experimenting, you may have picked up hepatitis C, and you also need to be tested. Now, one of the peculiarities about hepatitis C that's different in terms of its spread compared to hepatitis B is that hepatitis C is not easily spread by sexual contact. We rarely see in our clinical practice acute hepatitis C. It's usually silent, even in the adult, at the time of the infection. What we see is chronic hepatitis C, often picked up because an individual who has learned about hepatitis C will consult their physician if they have risk factors and undergo testing.

ANNOUNCER: Fortunately, most forms of hepatitis are preventable. Vaccines are available for hepatitis A and B. However, no vaccine currently exists for hepatitis C. If one does become infected, there are several medications available to treat and manage viral hepatitis.

EMMET KEEFFE, MD: The drug that we had originally was called standard interferon, and this was given by injection. Now, the response rates in the early days of the nineties were in the order of 10 percent or so eradication of the virus. But beginning in 1998 for hepatitis C, we had the onset of combination therapy, with not only standard interferon, but also a drug called ribavirin. And the combination of interferon plus ribavirin gets a 40 percent cure rate. Now, in hepatitis C we have the two pegylated interferons, which are long-acting and only need to be injected once a week. That's more convenient for our patients. And they're also more potent. So we now use pegylated interferon plus ribavirin, and overall we cure about 50 percent of patients with hepatitis C. Now, the case of hepatitis B, we have for treatment not only interferon but pegylated interferon is approaching licensure, because the studies that so far have been completed show promising results. We also have two oral agents, pills that are taken once a day. One is called lamivudine. The trade name is Epivir. And the other drug is called adefovir. Trade name is Hepsera. And both of those drugs are quite effective against hepatitis B.

ANNOUNCER: Although viral hepatitis is often a misunderstood and unrecognized disease, the bottom line for people that are infected is that research is continuing and the future looks bright.

EMMET KEEFFE, MD: The main thing I want people with hepatitis to know is that we have made tremendous progress in the past ten years, both diagnostically and therapeutically. And we've had remarkable progress in therapy, both for hepatitis B and C, and there's other drugs around the corner.

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