The month of May is Hepatitis Awareness Month. As a hepatologist, a physician specializing in the care of patients with all facets of liver disease, this is an especially important time of year for me. In the 25+ years that I’ve been practicing medicine, I am struck by the below average public awareness that liver disease and hepatitis receives compared to other diseases and disorders that are publicized in the lay press.
The amazing thing about liver disease, including hepatitis, is that the liver suffers in silence. By this I mean you may have no outward signs or symptoms to alert you that something is wrong. All too often, a scenario that I witness nearly every day in my office, is that patients come in months to years too late, when they are in a far more advanced stage of the disease. What may have been an easy fix then, now results in a conversation about cirrhosis (scarring of the liver), the possible need for a liver transplant, or even the likelihood of liver cancer.
Like it or not, we need to raise the awareness of liver disease, including hepatitis, with the general public. It is that serious.
What is hepatitis?
The starting point I always have in any discussion about hepatitis is to define exactly what hepatitis is. Very simply, hepatitis is inflammation of the liver. Just like any other medical term that ends with the suffix “itis”, it is the signal that we are talking about inflammation of a particular part of the body. For example, dermatitis is inflammation of the skin, sinusitis is inflammation of the sinuses, and bronchitis is inflammation of the bronchial tubes in the lung.
There are numerous causes of hepatitis. Unfortunately, the common misconception in the lay public is that anyone with hepatitis has some sort of contagious disease and probably should be quarantined. People think the person probably got hepatitis from doing something less than desirable, such as using drugs or a sexually transmitted disease. That is not the case, and, unfortunately, it leads to the unnecessary stigma that is associated with liver disease and hepatitis. In many situations, it delays proper evaluation because of the embarrassment of being labeled with hepatitis and liver disease.
What are the different types of hepatitis
The focus of hepatitis awareness month is on viral hepatitis A, hepatitis B, and hepatitis C. Before I delve into those specific causes, let me get a few other forms of hepatitis out of the way.
Autoimmune hepatitis is inflammation typically seen in young women and those with other autoimmune diseases, such as lupus and rheumatoid arthritis. In this situation, the immune system inappropriately attacks your liver, not realizing that it is part of you. This activation of the immune system results in damage, and inflammation of the liver and thus hepatitis. Autoimmune hepatitis is not contagious. It is treated with medications to suppress the immune system, such as steroids. Left untreated, autoimmune hepatitis can progress to cirrhosis and liver failure.
Shockingly, obesity and its associated metabolic syndrome is the leading cause of hepatitis due to fat in the liver. Nonalcoholic fatty liver disease (NAFLD) and a specific variant of this, non-alcoholic steatohepatitis (NASH), is a leading cause of liver disease in the United States and abroad and it is a leading cause of cirrhosis. It is sad to say that, inflammation due to fat, is the number one liver disease leading to cirrhosis and liver transplantation. This larger discussion of obesity, metabolic syndrome, and all of its associated devastating complications, both in adults and children, are the focus of my new book, Eating Yourself Sick: How To Stop Obesity, Fatty Liver, And Diabetes From Killing You And Your Family
Rounding out the non-viral causes of hepatitis include alcoholic hepatitis, related to excessive alcohol intake, as well as drug-induced hepatitis, related to idiosyncratic drug reactions that can take place following the administration of a wide number of medications that are available to us. Excess iron and copper, both of which are disorders of the genetic system, can lead to inflammation of the liver, and at times, cirrhosis of the liver in those affected individuals.
Regarding the three most common viral strains the first to discuss is hepatitis A. It is estimated that there are roughly 3,500 new infections each year. The good news is that hepatitis A has a very effective and safe vaccine that all children and adult should receive. Hepatitis A is spread through the fecal-oral route. In an infected person, hepatitis A is shed through their feces. Poor hand washing and sanitation will cross contaminate the stool from an infected person to another. This typically occurs with contaminated food or water, or handling other objects contaminated with the fecal matter from an infected person. Sex with an infected person can also result in transmission.
While usually not a deadly infection, those at extreme age, very young, or the very old, can develop extensive liver damage and liver failure from the infection. Those individuals with any form of underlying liver disease are also at risk for more serious complications from acute hepatitis A. Symptoms of hepatitis A may include fatigue, upset stomach, aches and pains, as well as abdominal pain due to swelling of the liver, and jaundice, which is yellowing of the skin in more advanced cases. Most cases resolved within a few weeks, though in a subset of patients, they may have a more protracted illness lasting several weeks to a few months.
Hepatitis B is a worldwide infection, with over 1.3 million people having chronic hepatitis B in the United States, with about 20,000 new infections each year. Hepatitis B is 50 to 100 times more contagious than HIV, and more than 2/3 of the people with hepatitis B do not know they are infected. One and 12 Asian-Americans has hepatitis B, and worldwide, hepatitis B is a leading cause of liver cancer, especially in Asian, and Asian-Americans. Hepatitis B should be considered a sexually-transmitted disease, spread through blood, semen, and vaginal fluid.
For those with hepatitis B, the determination by your healthcare provider includes classifying the infection as a new or acute infection, versus a chronic infection where the individual may have been infected years or decades earlier. Similar to hepatitis A, there are effective vaccines available, and all children at birth are vaccinated, as well as school and college students. Various health organizations recommend universal hepatitis B vaccination. For those with chronic hepatitis B infection, there is the risk of progressing to cirrhosis, and the need for liver transplant. There are effective medications to control hepatitis B.
Hepatitis C affects over 3 million people in the United States, with about 30,000 new infections each year. Similar to hepatitis B, more than half of those currently infected with hepatitis C do not even know they are infected. 75% of those with hepatitis C today were born between 1945 and 1965. This is the rationale behind universal screening for all baby boomers, regardless of risk factors. The typical risk factors for hepatitis C include a past history of intravenous or intranasal drug use (even if you tried it only once), tattoos and body piercing, blood transfusions before 1992, sexual promiscuity, gay men, dialysis patients, as well as healthcare workers and first responders. Many patients with hepatitis C have no symptoms, but other vague symptoms such as fatigue, muscular aches and pains, and vague abdominal complaints may delay the diagnosis and treatment if hepatitis C is not being thought of. Similar to hepatitis B, left untreated, hepatitis C has a 17% chance of developing into cirrhosis, a percentage that is significantly increased with chronic alcohol use. There are exquisitely effective medications to treat hepatitis C, with a better than 95% cure rate. Different than hepatitis B, hepatitis C is very poorly spread sexually.
Going beyond hepatitis awareness month
So during this hepatitis awareness month, it is my hope that we continue to raise attention every day of the week regarding the diseases that affect the liver, and what you need to do to avoid liver damage and maintain a healthy liver. The ongoing stigma associated with liver disease needs to be overcome, and the only way we can do that is by arming our friends and neighbors with the information that they need to have.