Hepatitis A, B, C, D and E – what should you know?

Proven content

Did you know that the hepatitis B virus is much more contagious than HIV? Did you know that out of 3 people infected with the type B virus, only one knows about their disease? Hepatitis is a disease that takes various forms depending on which virus you catch. What is viral hepatitis (viral hepatitis) caused by viruses type A, B, C, D and E?

Viral hepatitis (hepatitis) – the main risks

Viral hepatitis (hepatitis), colloquially but incorrectly also referred to as jaundice (which is just one of the potential symptoms), is a viral disease. The disease is caused by different types of viruses, which is why it is called hepatitis A, B, C, D or E. Each type of hepatitis occurs with a different frequency, and the course of the disease, the nature of the symptoms and the treatment method are different. Particularly common and dangerous diseases include hepatitis B and hepatitis C.

The most common symptom of infection with the type B virus there is jaundice, which, however, does not occur in all patients. Many of them may develop flu-like symptoms or mild food poisoning. Often the infection is latent. The immune system produces special proteins – cytokines (TNFα or IFNγ) that inhibit the expression of the virus genes and prevent the virus from multiplying. But it is still there. It may be reactivated in immunosuppressed patients, e.g. as a result of chemotherapy or transplantation. Then, acute hepatitis may occur – explains Prof. Waldemar Karnafel from the Department of Gastroenterology and Metabolic Diseases at the Medical University of Warsaw.

Hepatitis B or C infection are the main risk factors for developing hepatocellular carcinoma (Hepatocellular carcinoma). In the world, hepatocellular carcinoma is the third most common cause of death from neoplastic diseases. In Polish statistics, HCC ranks further because Poland is one of the countries with a low incidence of this cancer. The development of hepatocellular carcinoma is insidious and it takes 30 to 50 years from infection with hepatitis B or C virus to disclosure. Earlier, about 20–25 years after infection, cirrhosis of the liver appears.

80–90% of hepatocellular carcinoma develops in the cirrhotic liver. At some point, ordinary regenerative nodules turn into dysplastic nodules, and hence it is only a step to the development of cancer. That is why they are so important preventive actions in the entire population: vaccinations or screening tests to detect chronically infected people. In the case of diagnosis of hepatitis B or C infection, not only treatment is applied, but also detailed long-term supervision over patients, consisting in systematic semi-annual ultrasound of the liver and determination of the concentration of AFP (α-fetoprotein) in order to early detect hepatocellular carcinoma.

Read also: Who is liver cancer treatment for?

Here is an overview of the types of hepatitis viruses, taking into account epidemiological data, course, treatment and prevention methods. These are pathogens that can cause acute and chronic inflammation.

The HepaDr dietary supplement will be suitable for prophylactic and auxiliary treatment of viral hepatitis. in tablets from the Diather brand.

Acute hepatitis A

Cause: HAV virus which is an RNA virus of the family Picornaviridae

Epidemiology: infection with this type of virus accounts for half of all cases of hepatitis (viral hepatitis). Annually, 1,4 million people are sick worldwide, while in Poland – about 5000 people, mainly children aged 10–14. Poland is a country with an average risk of developing the disease. Cases of illness should be reported to the local SANEPID station.

Routes of infection: mainly by food (dirty hands, poor sanitation!); less often through sexual contact or contaminated medical equipment.

Specific risk factors: close contact with the patient (living together), human clusters (schools, kindergartens, nursing homes), traveling to endemic countries (developing countries, Eastern Europe and Our Country, Mediterranean basin), eating raw seafood (oysters), work when removing municipal waste.

Hatching period: 30 days on average (15–50 days). The virus is mainly excreted in the faeces, so any form of contact with human faeces can be contagious.

Course of illness: 3 types of disease course are possible: jaundice (the most common), jaundice and cholestatic. Typical symptoms include fatigue, abdominal pain, nausea, vomiting, muscle and joint pain, “flu-like” symptoms. Additionally, jaundice or itching of the skin (in cholestatic form) may appear. When jaundice occurs, the urine becomes dark beer and the stool becomes discolored. The disease lasts on average 6 weeks and rarely exceeds 3 months.

Laboratory tests: an increase in the activity of ALT and AST transaminases, mainly the former, in the case of jaundice, an increase in total bilirubin, in the cholestatic form, additionally an increase in the enzymes ALP and GGTP.

Serological tests: initially, anti-HAV antibodies in the IgM class appear (they may persist up to 6 months), then anti-HAV antibodies in the IgG class appear and remain for the rest of their lives.

Histological examination of the liver: it is not needed for recognition.

Treatment: symptomatic – rest, a 2000 kcal diet containing 70% of easily digestible carbohydrates, avoiding hepatotoxic drugs and stimulants (alcohol!), it is necessary to rehydrate, antiemetic or antipruritic drugs (cholestyramine, ursodeoxycholic acid).

Complications: very rare (0,1%) fulminant hepatitis.

Prevention: compliance with basic hygiene rules, anti-HAV vaccine.

Acute hepatitis B and D

Cause: Hepatitis B causes HBV is a DNA virus (Hepadnaviridae), while hepatitis D causes HDV, which is an RNA virus. Infection with type D virus is possible only in people infected with type B virus (co-infection).

Epidemiology: around 350 million people are ill in the world, in Poland at the turn of the 70s and 80s the incidence was 43/100 000 inhabitants. After the introduction of compulsory vaccinations against hepatitis B, this number dropped to 0,34 / 100 inhabitants. Most cases of the disease occur in Eastern Europe, Asia, China, Our Country, Africa, Central and South America. The disease should be reported to the local SANEPID station.

Routes of infection: parenteral (mainly through blood), sexual, perinatal.

Specific risk factors: contact with infected blood (non-sterile conditions, medical equipment – e.g. contaminated needles, but also common items such as a toothbrush, shaver), frequent sexual contact, infection during childbirth and through the placenta during pregnancy.

Hatching period: an average of 70–80 days (30–160 days), and blood is the main infectious material.

Course of illness: basically a picture like hepatitis A, only symptoms increase slower. Overall, the course is more severe, especially in the case of jaundice. Acute disease lasts from 2 to 6 months.

Laboratory tests: as in the case of hepatitis A.

Serological tests: typical for hepatitis B is the appearance and disappearance of antigens and antibodies in a characteristic sequence. The first to appear is the genetic material of HBV DNA and the HBsAg and HBeAg antigen, then the antibodies against the anti-Hbc core antigen, then the anti-HBe and anti-HBs antibodies. Antibodies are slowly disappearing (first anti-HBe, then anti-HBs). IgG anti-HBc antibodies remain for life.

Histological examination of the liver: it is not necessary for the routine diagnosis of acute disease. Recommended only in severe or doubtful cases.

Treatment: as in the case of hepatitis A; treatment with glucocorticosteroids is contraindicated as it facilitates the development of chronic inflammation.

Complications: 2–10% of acute infections turn into chronic infections. Others include fulminant hepatitis (1%), polyarteritis nodosa, glomerulonephritis with nephrotic syndrome, rheumatic polymyalgia, and Guillain-Barré syndrome.

Prevention: strict adherence to the rules of sterilization of medical and cosmetic equipment (hairdressers, beauticians, tattoo studios). Absolute adherence to the rules of blood and blood products circulation (tests on donors and recipients). In Poland, the vaccine against hepatitis B is mandatory.

Superinfection with hepatitis D virus: only a few cases of the disease have been described in Poland. It is an incomplete virus that can replicate only in the presence of HBV. The routes of transmission are the same as for HBV. However, once infected, acute hepatitis B becomes much more severe, and may result in fatal hyper-acute hepatitis.

Acute hepatitis C

Cause: HCV virus which is an RNA virus of the family Flaviviridae. It has 6 genotypes, among which there are subtypes characterized by resistance to treatment.

Epidemiology: around 170 million people are infected in the world, and around 700 patients in Poland. About 000 new cases are diagnosed in our country each year. Infections are mostly inpatient or outpatient. Most people are infected among drug addicts, and it often coexists with HIV infection. In hemodialysis patients, this percentage is 2000–30%. Cases of infection should be reported to the local SANEPID station.

Routes of infection: infection through contact with blood and its derivatives, medical and non-medical equipment (even ordinary items such as a toothbrush, shaver), sexual contact (frequent change of partners), during childbirth. In half of the patients, the source of infection cannot be determined.

Hatching period: 50 days on average (15–160 days), mainly blood is contagious.

Course of illness: generally asymptomatic. Often the only symptom is a slight enlargement of the liver. If the disease is symptomatic, it runs like mild hepatitis B or A.

Laboratory tests: as in the case of hepatitis A. If there are problems, they are usually less severe.

Serological tests: the genetic material of HCV RNA is detectable 1–4 weeks after infection, and anti-HCV antibodies within 4–10 weeks. After three months, anti-HCV antibodies appear in 90% of patients. The viral genetic material enters the bloodstream in relapses, and therefore these tests should be repeated. So far, it is not possible to detect anti-HCV antibodies in the IgM class, which would allow the diagnosis of the acute phase of the disease. For this reason, it is often difficult to distinguish acute hepatitis C from chronic.

Histological examination of the liver: may be helpful in distinguishing the acute from the chronic phase of inflammation.

Treatment: symptomatic as in other types of viral hepatitis. There is controversy over the use of antiviral therapy in acute hepatitis C. Treatment delay is due to the fact that, over the course of the following months, the virus is eliminated spontaneously. If treatment is undertaken, alpha interferon or pegylated interferon are used.

Complications: 5-20% of acute infections turn into chronic inflammation. Others are (very rarely) fulminant hepatitis and glomerulonephritis.

Prevention: rigorous adherence to the rules of blood and blood products trading (tests on donors and recipients), proper sterilization of medical and non-medical equipment.

Hepatitis E.

Cause: HEV virus which is an RNA virus of the family Caliciviridae

Epidemiology: endemic diseases in Asian countries with a low standard of hygiene, often through the consumption of contaminated water. Only a few cases of the disease have been reported in Poland. The disease must be reported to the local SANEPID station.

Routes of infection: by the alimentary tract; the pathogenesis is not fully understood, the virus multiplies in the gastrointestinal tract.

Course of the disease and treatment: as in the case of hepatitis A. The course of the disease is usually mild, with the exception of women in the last trimester of pregnancy, where there is a high risk of fulminant hepatitis. Hepatitis E does not become chronic.

Prevention: no vaccine; strict hygiene rules are required.

Other viruses that can cause hepatitis include Epstein-Barr, cytomegalovirus, herpes simplex, rubella, chicken pox, measles, yellow fever, as well as ECHO viruses and adenoviruses.

Chronic hepatitis B

It is a liver disease with necroinflammatory changes. He’s calling her persistent (more than 6 months) infection with type B virus (HBV). Many studies show that people who have had acute hepatitis B may still be infected with HBV, but the infection is latent. It can therefore be assumed that latent infection does not lead to serious liver damage in patients whose immune system is functioning properly. However, the presence of an additional hepatic damaging agent (e.g. HCV infection) may favor the progression of liver disease. Some data indicate that latent HBV infection may cause the progression of fibrosis and contribute to the development of liver cirrhosis. It seems that the explanation of these contradictions is the duration of overt infection with the type B virus – comments Prof. Waldemar Karnafel.

In Poland, we have approximately 700 people with chronic hepatitis B, predominantly male. HBV virus is oncogenic virus, its potentially fatal complication is hepatocellular carcinoma (HCC). The risk factors for the transition of acute inflammation to chronic are: perinatal or early childhood infection, non-jaundice course of the acute phase of the disease with a small increase in ALT activity, male gender, older age, immunosuppression (including the use of glucocorticosteroids).

Most patients do not feel any discomfort. The feeling of fatigue and depressed mood dominate. Jaundice may recur, but more often the first symptom of the disease is markers of cirrhosis. The disease progresses with relapses – periods of exacerbation are intertwined with periods of silence. Laboratory tests show an increase in the activity of transaminases, ALT greater than AST, periodically the concentration of bilirubin may increase. However, the most important are the serological markers: HBsAg is still present, which proves that the virus has not been eliminated from the body. HBeAg antigen or anti-HBe antibodies may also be present, as well as copies of the viral genetic material – HBV DNA, which proves its intensive multiplication.

Histological examination of the liver is necessary to establish the degree of progression of fibrosis and necrotic changes in this organ and until the disease is finally diagnosed. Treatment consists in introducing complete abstinence from alcohol and avoiding hepatotoxic drugs. Patients at risk who have not had hepatitis A infection should be vaccinated against this type of virus. Antiviral treatment is aimed at permanent elimination of the virus and at the inhibition of the progression of the inflammatory process leading to cirrhosis.

Depending on the constellation of serological tests and the degree of changes in the histological examination, as well as on the contraindications to treatment, different treatment options may be adopted. Interferons (alpha 2a, alpha 2b, pegylated) are used for not less than 48 weeks or nucleoside / nucleotide analogues – adefovir, lamivudine, telbivudine, entecavir, tenofovir. Some patients may qualify for liver transplantation. The complications of chronic hepatitis B are serious – approximately 8-20% of patients will develop cirrhosis, 2,2% of patients with compensated cirrhosis will develop hepatocellular carcinoma, and 10% of those with decompensated cirrhosis! That is why constant monitoring of the health of patients with chronic hepatitis is so important. Less common complications include autoimmune diseases associated with the presence of immune complexes: cryoglobulinemia, polyarteritis nodosa, glomerulonephritis.

Chronic hepatitis C

It is a necro-inflammatory liver disease that lasts more than 6 months and is caused by the hepatitis C. The number of chronically infected people in Poland is not exactly known, it is estimated that it is about 750 people, mostly male. Specific factors of the development of chronic infection are similar to those in the case of hepatitis B, additionally we distinguish here infection related to blood transfusion – large volumes or multiple recipients.

HCV is, like HBV, an oncogenic virus and can cause hepatocellular carcinoma. The course of the disease is asymptomatic or patients complain of non-specific ailments, such as fatigue, bad mood, pain in muscles and joints, itching of the skin, Raynaud’s phenomenon. Hepatitis C is a disease with slow progression, and often the first symptoms are liver cirrhosis. For diagnosis, it is necessary to confirm the characteristic changes in the liver biopsy and the persistence of the genetic material of HCV RNA in the blood for more than 6 months.

The general management guidelines are similar to those in the case of hepatitis B, namely: absolute avoidance of alcohol, vaccination against hepatitis A and hepatitis B, and in the case of obese patients, weight reduction is also recommended. Antiviral treatment is aimed at eliminating the virus, as well as preventing the development of liver cirrhosis and the transformation of neoplasms into HCC. The therapy uses pegylated interferon in combination with ribavirin. Treatment lasts from 16 to 72 weeks. Some patients may be eligible for liver transplantation.

The complications of this disease are also very serious. Cirrhosis will develop in 5-20% of patients within 20-25 years. The progression to cirrhosis depends on the degree of fibrosis and the severity of the inflammatory process, with 100% of patients with severe fibrosis developing cirrhosis. 5% of patients with chronic hepatitis C will develop hepatocellular carcinoma. And in this case, it is particularly important to monitor the patients’ health condition – ultrasound of the liver and determination of the concentration of AFP (α-fetoprotein) every six months.

Text: lek. Aleksandra Kapała, internal medicine specialist, Daytime Chemotherapy Department, Oncology Center – Institute of M. Skłodowskiej-Curie

Read also:

1. Symptoms of a sick liver – how to recognize?
2. Liver pain – treatment, home remedies. When to see a doctor?
3. Vaccine against hepatitis A, B, C – when and what?