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What is Viral Hepatitis?

Viral Hepatitis refers to inflammation in the liver caused by a virus. There are 5 different viruses that can cause Hepatitis, these are known as Hepatitis A, B, C, D and E. Their prevalence varies across the world; the most common ones are Hepatitis B and C. 

Collectively viral hepatitis affects hundreds of millions of people worldwide. Their prevalence varies in different countries but the most common ones worldwide are Hepatitis B and C. 

Who is at risk of Hepatitis C?

Hepatitis C is a blood-borne virus meaning that you have to come into contact with contaminated blood in order to contract the virus. The people most at risk are those who have been exposed to infected blood and blood products. These are:

  • people who inject drugs (including anabolic steroids), especially if they share any drug related equipment 
  • people who received blood products in the UK before September 1991 
  • people who have received medical treatment or blood products in a country where hepatitis C is common

Who is at risk of Hepatitis B?

The hepatitis B virus can be caught if you come into contact with the blood or bodily fluids of an infected person. You may be at risk if:

  • You have received dental or medical treatment or had a tattoo or piercing with unsterilized equipment
  • You have shared a razor or toothbrush with an infected person
  • You have had unprotected sex with an infected person
  • You have injected drugs with a shared needle

Hepatitis B is more common in some parts of the world than others. You have a higher risk of having been exposed to hepatitis B if you have ever lived in a high-risk country. Click here for a prevalence map

What are the symptoms of Hepatitis C?

Many people with hepatitis C don't have any symptoms and are unaware they have the infection. They may develop symptoms later on as their liver becomes increasingly damaged.

Only around one in every three or four people will experience symptoms during the acute phase of the infection (during the first six months). Possible symptoms may include, tiredness, abdominal pain, loss of appetite, feeling and being sick and jaundice (yellowing of the whites of the eyes and skin).

Approximately 25% of people who are infected with the hepatitis C virus will get better on their own without the need for any medication. Whilst the remaining 75% of people will develop chronic hepatitis C.

Some of the most common symptoms experienced by people with chronic hepatitis C include: feeling tired all the time, joint and muscle aches and pain, feeling sick, problems with short-term memory, concentration and completing complex mental tasks (also known as "brain fog”), mood swings, depression, anxiety, indigestion, abdominal pain, bloating and itchy skin.

What are the symptoms of Hepatitis B?

Many people with hepatitis B won't experience any symptoms and may fight off the virus without ever realising they had it.

If symptoms do develop, they usually occur 2-3 months after infection. Symptoms may include:

  • Flu-like symptoms, including tiredness, a fever and general aches and pains
  • abdominal pain
  • loss of appetite
  • feeling and being sick
  • jaundice (yellowing of the whites of the eyes and skin)

In acute cases of hepatitis the body’s own immune system will clear the virus within 6 months of infection whilst in chronic cases of hepatitis, treatment with medication will be required. 

How is viral hepatitis diagnosed?

Viral hepatitis is diagnosed by a blood test which checks for the presence of anti-bodies. If a person has been infected with one of the hepatitis viruses their immune system will have created anti-bodies to defend itself against the virus. A positive test result indicates that you have been infected at some stage but you may have since cleared the virus from your body.

A PCR or RNA blood test checks whether the virus is still live and reproducing inside your body. If the virus is live this test also calculates the amount of virus that is in your blood stream. This is known as your viral load. 

What is the treatment for hepatitis C?

In the past few years treatment for hepatitis C has improved significantly. Treatment used to consist of Pegylated Interferon and Ribavirin, which has a long treatment duration (up to 48 weeks), is administered via a combination of injections and tablets, has unpleasant side effects and relatively low rates of success.

However, there are now some newer and more effective treatments available. These are known as direct acting anti-virals and go by a variety of names. Treatment with direct acting anti-virals is generally much shorter, typically 8-12 weeks, it has less unpleasant side effects, is administered only via tablets and has a much higher success rate (90% approximately).

Whilst on treatment your viral load will be closely monitored. If the treatment is working the viral load will decrease until it is undetectable.

What is the treatment for hepatitis B?

If you know that you have been exposed to the hepatitis B infection (or find out within a week of that exposure); you can have emergency treatment to help your body to fight the virus off. This will consist of a dose of hepatitis B immunoglobulin followed by treatment with the hepatitis B vaccine.

However, if you did not realise that you were exposed to the virus at the time of infection and so were not able to access emergency treatment; it is still possible that your body will fight the virus off by itself. You will therefore generally not be offered anti-viral treatment at this stage.

You will need to have regular blood tests to check whether your body has managed to fight off the virus or not. If your blood tests show that you still have hepatitis B after 6 months it is likely that you will have become chronically infected.

If you develop chronic Hepatitis B you will need to be monitored regularly to assess whether the virus is causing fibrosis within the liver. This may be assessed via a liver biopsy or a Fibroscan.

If fibrosis is starting to accumulate you may be offered treatment to slow it down and prevent the development of cirrhosis. If you are relatively healthy you may be offered Peginterferon alfa-2a which stimulates the body’s immune system to attack the virus. This can help to reduce the amount of the virus within the body but might not permanently clear all of the virus. It is usually administered by weekly injections for 48 weeks. It is common to experience flu-like symptoms for the first 24-48 hours after the injection but this tends to lessen over the weeks.

If your body does not respond to Peginterferon alfa-2a or it is not suitable for you, you may instead be offered an anti-viral medication such as, tenofovir or entecavir. These are both administered as tablets and their most common side effects are, feeling sick, vomiting and dizziness.

Are there any viral hepatitis support groups I can contact?

For support with hepatitis C in the UK visit the Hepatitis C Trust or for support with hepatitis B visit the Hepatitis B Foundation

What do patients with viral hepatitis say about LiverMultiScan?

Click here to read an account from a patient with hepatitis C who took part in the Patient LiverMultiScan study.