Everything about HEPATITIS

WHAT IS IT?
Your liver is your largest and-after your heart-your hardest working organ. It does about 5,000 vital jobs, from cleansing blood to helping digest food. You can't live without it.
The term hepatitis means your liver is inflamed and can't function well. There are many types of hepatitis. Some are short-lived and mild: Your liver repairs itself and suffers no lasting damage. But other types can lead to cirrhosis (scarring of the liver) and cancer. Some will progress to liver failure (in which case you need a liver transplant) or even death.
By far the most common is viral hepatitis, which comes from a group of highly contagious viruses that target the liver. The six main types of viral hepatitis are each named for a letter of the alphabet, in the order they were discovered.
Hepatitis can also be brought on by longtime heavy alcohol use, other diseases, drug reactions, or poisons such as industrial chemicals.
If you have hepatitis, you and your doctor can do a lot to preserve your liver function. A liver transplant is a last resort.

HEPATITIS: SYMPTOMS
Hepatitis is sneaky: You may have no signs at all when your liver is first attacked, or symptoms so slight you don't even notice them. Children with hepatitis tend to have slight symptoms.
If you do have symptoms, they are the same for almost any hepatitis and are much like those of a long-lasting flu. First you may notice:
 Fever and fatigue.
 Nausea, vomiting, and loss of appetite.
 Abdominal pain.
Less common symptoms, or signs of advanced disease:
 Dark yellow or brown urine.
 Clay-colored stools.
 Jaundice-yellow eyes and skin.
 Blood in your stool or the vomiting of blood.
All can be signs of some other virus or mild ailment. But call your doctor if you have these signs and have been exposed to hepatitis, have a form of hepatitis, or have had hepatitis before.
The specific types of hepatitis may have these specific symptoms:
 Fecal-oral: These types come on quickly and may make you feel as if you have a mild flu or make you quite sick for a short time. Many people-chiefly children-have no symptoms. Nearly everyone with A gets better in about a month and is then immune and can't get it again. A vaccine can prevent it. Hepatitis E, which can last many months, has no vaccine. It can be deadly for pregnant women.
 Blood-borne: As with HIV, you may have few or no symptoms when you are first infected. Many people feel better after a few months or with drug treatment.
Most people recover from B in three to six months, and some will get rid of the virus. C is a serious disease; it's known as a "silent" killer because liver failure may be its very first sign.
Some people remain able to pass the illness along to others even if they have no symptoms: 5 to 10 percent with B and up to 85 percent with C have it forever. Liver cancer rates are high with B and C, and hepatitis C is the single greatest cause of people needing liver transplants. It accounts for more than 30 percent of liver transplants in the United States today.
Hepatitis D infects only those who already have B and makes it more severe. Although little is known of the newly found hepatitis G, it does not appear to be a serious form of the disease.
 Alcoholic: You may have no symptoms, or you may have nausea, vomiting, fever, and pain in the tender, enlarged liver. There is no treatment, but if you stop drinking alcohol at this stage, the liver may get well again. If not, the disease will progress to cirrhosis.
Chemical: You may have flu like symptoms, perhaps with headache,

WHAT IS HAPPENING?
Think of your liver as a factory. It helps process food, makes proteins, and controls hormone balance and blood clotting; it stores vitamins, iron, and fat; it clears away used blood cells; and it filters drugs, alcohol, and other poisons out of your bloodstream.
All of this takes place in a three-pound organ roughly the size and shape of a football. It sits tucked up under your rib cage on the right side of your body.
When your liver is attacked by disease or weakened by poisons, it swells and becomes tender. The swelling stretches it, blocking proper blood flow and damaging cells. As the disease progresses, cells die and your liver function slows down or stops.
The decline in liver function can happen all at once when you first get hepatitis, or it can take many years. Some people first find out they have hepatitis only after much of their liver has been destroyed. Or they may find out they have viral hepatitis when they try to donate blood or semen.
Most kinds of hepatitis can't be cured. But if you get rid of the source of the damage soon enough, your liver can repair itself to some degree.
 sleepiness, or fever.

WHAT CAUSES IT?
Your liver can be damaged in many ways, but the most common are:
Viral hepatitis, the major cause. These viruses come in two forms, according to how they infect the body:
 Fecal-oral types A and E. These viruses are spread through feces; sewage-tainted food, seafood, or water; dirty-hand-to-mouth contact; or sexual contact. They're common in places with poor water and toilet facilities, mostly in developing countries. Hepatitis A is also common in this country: It sometimes shows up in day care centers with poor hygiene. Hepatitis E is common in India, Asia, and Africa but is rare in the United States.
 Blood-borne types B, C, and D. These are spread through body fluids in much the same way that HIV (the human immunodeficiency virus that causes AIDS) is: by intravenous (IV) needles, blood, childbirth, and sex. Hepatitis C is rarely spread by sexual contact.
Nearly a third of people with B or C don't know how they got it. Some may have been infected by blood treatments or transfusions more than 20 years ago, before blood was screened for the virus.
Hepatitis C can progress very slowly. Many people die of some other cause long before the hepatitis virus destroys their liver. There is no way to tell for sure how the disease will progress. Not knowing is often very stressful for those with viral hepatitis.
Nonviral hepatitis, meaning any other kind of liver damage:
 Alcoholic hepatitis from years of heavy drinking, which often progresses to cirrhosis.
 Other diseases, such as autoimmune diseases, in which the body turns on itself.
 Drug-induced or chemical hepatitis from drugs or mixing drugs; poisons such as carbon tetrachloride, used in cleaning products; and poisonous mushrooms.


THINGS YOU CAN'T CHANGE
Random risk of hepatitis virus infections
Hepatitis is out there, in hundreds of millions of people of every race, culture, and social level. Good health habits, safe sex, and vaccination are your best defenses, but they may not be enough: About a third of all people with B or C don't know how they got infected.
THINGS YOU CAN CHANGE
Immunity from A and B
So far, we have vaccines only for A and B (but the B vaccine prevents D as well). If you don't get the vaccine, you are at risk for both.
Alcohol and medications
Your liver filters toxins from your blood. Alcohol is poisonous to a healthy liver and worsens hepatitis from other causes. Also, some prescribed and over-the-counter drugs-including acetaminophen (such as Tylenol) in large amounts or with alcohol-can damage your liver.
Risky behavior
Injected drugs, body piercing, tattooing, and unprotected sex can give you viral hepatitis-not to mention AIDS. Both diseases can be fatal. Also, eating some poisonous types of wild mushrooms destroys liver tissue.
Travel habits
Sampling street food can give you more than a bellyache, and so can intimate contact with strangers. When you travel in places with poor toilet facilities, you need to be extra careful.
Workplace hazards
Health-care workers are at risk from blood-borne viruses present in body fluids. Those in industry and the cleaning and building trades may be exposed to chemicals or to virus-tainted food or waste. Extra care-or a job change-can lower risks.

WHAT YOU CAN DO FOR YOURSELF
Get prompt treatment
If you know you've been exposed to viral hepatitis, see your doctor right way. Tests and treatments may prevent it in the early stages.
Get vaccinated
Once you get one of the hepatitis viruses, you can't get it again-but you can get another, so get vaccinated against those you don't have.
Get a vaccination for hepatitis A if you plan to travel or live in a place where it's widespread or that has poor water or toilet facilities, or if you have (or had) some other form of hepatitis. It takes two to four weeks for the vaccine to take effect, but you can get faster acting short-term shots.
Get a vaccination for B if you have some other form of hepatitis, have more than one sex partner, work in a health field, travel widely, or live with anyone who has B or who is from Asia, where it is widespread. The B vaccine is now given to babies at birth and is urged for all teenagers before they are sexually active. It also protects against D.
Don't drink alcohol
Don't drink alcohol, or don't drink much. Alcohol causes hepatitis and cirrhosis-and it makes a sick liver much worse. Some doctors say you can drink lightly after you have recovered from some forms of hepatitis; others insist no alcohol is good for you. Ask your doctor. If you have a drinking problem or are an alcoholic, get help right away.
Focus on a healthy lifestyle
Good overall health and health habits let an ailing liver try to repair itself. Avoid extremes of diet or activity. Rest as much as you need to. Eat frequent small, well-balanced meals. Drink at least eight glasses of water each day.
Don't smoke, exercise lightly (when you feel well enough or your doctor says it's okay), and avoid alcohol and drugs.
Be careful with medicines
Some prescribed and over-the-counter drugs can harm your liver, including acetaminophen (Tylenol) taken with alcohol, and aspirin. Ask your doctor about any drugs you may be taking. To avoid drug damage, be sure each doctor you see knows you have (or have had) hepatitis.
Stay optimistic
Hepatitis can kill-but it may take decades and most people who have it don't die of it. So you should live as normal a life as you can. If you have chronic hepatitis, accept it as part of your life and try not to worry. Join-or start-a support group.

Have regular checkups with a specialist
Stay in touch with a liver expert. A doctor who knows about the liver can look for patterns and changes in your illness and will know about new drugs and treatments as they come out. New treatments for viral hepatitis are being tested now.
Prevent Hepatitis
Protect others from viral hepatitis
Suggest testing for those close to you. Use a condom and practice safe sex to avoid getting another kind of hepatitis and to avoid spreading hepatitis to others if you are infected. Don't donate blood or semen if you're infected.
Hepatitis A and E
 While in areas with poor sanitation, drink only boiled or bottled fluids and don't use ice cubes. Eat only cooked foods (above all do not eat raw shellfish) or fruits and vegetables that you peel yourself.
 Wash your hands with soap and water after using the toilet or changing a diaper and before touching food or your mouth.
 If you are infected with A or E, don't prepare or touch others' food. Take extra care to wash hands, clothing, and bedding.
Hepatitis B, C, and D
 Use the same safeguards as for HIV: Take care with blood and body fluids. Use condoms and practice safe sex. Don't share IV needles, manicuring tools, razors, toothbrushes, or other items that can collect or hold blood.
 Be sure that only sterile needles are used for acupuncture, body or ear piercing, or tattoos. Wear latex gloves when cleaning up others' body fluids.
Hepatitis from alcohol and poisons
 Don't drink, or don't drink much-no more than two drinks per day for a man, one for a woman (a drink is 1 1/2 ounces of hard liquor, 5 ounces of wine, or 12 ounces of beer).
 Take care when using toxic chemicals (such as carbon tetrachloride, in some cleaning products) at home, at work, or in the garden: Read and follow label warnings. Don't use poisons in closed places.
 Don't eat any wild food such as mushrooms unless you're an expert at recognizing which ones are safe.
 Get to a hospital right away if you have been exposed to poisons or have any symptoms of liver damage.
 Be sure your doctor knows all the drugs you're taking. Read the labels before taking-or mixing-over-the-counter drugs.

WHAT YOUR DOCTOR CAN DO FOR YOU
There is no cure-yet-for any type of hepatitis, but today's treatments can slow the disease and protect your liver.

Tests
Your doctor may give you liver function tests to see how well your liver is working. If he or she needs more facts, you may be given a biopsy: A long, thin needle is slipped into your liver to sample a piece of tissue. Your doctor may repeat tests to check your progress.
Tests for viral hepatitis can tell whether you have it or have had it, which one you have, and whether you are a carrier.
Vaccines
See your doctor right away if you aren't vaccinated. Your doctor may give you gamma globulin for hepatitis A or immune globulin (HBIG) for hepatitis B to help prevent infection.

Treatment
Many cases of hepatitis need no treatment. You and your doctor decide how much rest you need. Most people don't need a hospital stay unless they have a severe illness or can't drink fluids or eat.
Hepatitis A, B, and E most often go away by themselves. But if a hepatitis infection lingers for more than a few months, you'll have to attack the virus with one or more powerful medicines.
The main weapon against chronic hepatitis B is lamivudine, a drug that keeps the virus from dividing. After three to six months of treatment, the virus becomes so scarce that it no longer shows up in blood tests. The infection can flare up if a person stops taking the medicine, but it won't be as dangerous as it was before. For this reason, some patients can safely stop taking the drug after a year or two.
Before the approval of lamivudine in 1998, a drug called interferon alpha 2b was the only available treatment for hepatitis B. The drug is effective, but unlike lamivudine it often causes serious side effects such as flulike symptoms, fever, depression, and muscle pain.
Interferon alpha 2b is still the best choice for treating hepatitis C. Patients can either take the drug by itself or combined with the antiviral drug ribavirin. In general, the two-drug combination is more likely than interferon alone to slow down the disease. Ribavirin doesn't cause as many side effects as interferon, but it can make a person anemic.
Alcoholic hepatitis has no treatment other than quitting alcohol and eating a balanced diet.
Acetaminophen overdoses have an antidote, and another drug may counter mushroom poisoning. Other types of poisoning may be treated by flushing the substance out of the body within 48 hours after exposure. If you have hepatitis from chemical exposure, your body can often repair the damage if you avoid the chemical.
A liver transplant is a last-chance treatment.

SOME WORDS YOU MAY HEAR
Acute: onset and first six months of a disease.
Ascites: abdominal swelling due to fluid buildup.
Interferon alpha 2b: antiviral drug for hepatitis B and C.
Bile: yellowish fluid made by the liver to aid digestion.
Bilirubin: yellowish fluid of broken-down red blood cells that in excess amounts causes jaundice.
Biopsy: removal of a tissue sample to check under a microscope.
Chronic: ongoing disease lasting six months or more.
Cirrhosis: scarring of the liver, which sometimes progresses to cancer or liver failure.
Contagious: able to be passed to another person.
Encephalopathy: swelling of the brain; a result of advanced liver disease.
Gamma (or immune) globulin: human blood product rich in antibodies given to protect those recently exposed to hepatitis A.
Gastroenterologist: doctor who treats problems of the digestive system, including the liver.
Hepatocellular carcinoma: a form of liver cancer.
Hepatologist: doctor who is an expert on the liver and its diseases.
Hepatitis B immune globulin (HBIG): human blood product rich in antibodies given to protect those recently exposed to hepatitis B.
Inflammation: swelling, with redness, heat, and tenderness.
Jaundice: yellowed skin and whites of the eyes from liver disease.
Liver function test: a blood test for liver health that measures enzymes leaked by liver cells.
Liver enzymes: substance produced by liver cells to help the liver do its work.
Nonviral hepatitis: liver disease that is neither caused by a virus nor caught from others.
Toxin: poison or harmful substance.
Transplant: replacement of a diseased organ, such as the liver, with a healthy organ or tissue from another person.
Viral hepatitis: disease from the hepatitis viruses that can be caught from others. Types A, B, C, D, and E are the most common.

LATEST DEVELOPMENTS
Amantidine
Interferon and ribavirin may not be the last word in hepatitis C treatment. In 2000, Italian researchers reported that a triple-drug combination-these medicines plus the antiviral drug amantidine-seemed to be more potent than the standard two-drug treatment. In their study, 40 patients received all three drugs, and 20 took just interferon and ribavirin. After 12 months of treatment and 6 months of follow-up, each subject had a blood test to check for the hepatitis C virus. Half the patients on the three-drug treatment showed no signs of the virus; only 5 percent of the other patients had the same result.
Amantidine, already FDA-approved as a flu drug, is readily available and relatively inexpensive. If you're already taking interferon and ribavirin for hepatitis C, ask your doctor if it's right for you.
Living donor liver transplant
A different kind of breakthrough may help save the lives of patients with liver failure. Instead of waiting for a transplant, they can now receive a part of a liver from a healthy friend or relative. (In 1999, more than 1,000 people died while on a liver transplant waiting list.) In both the donor and the patient, the liver then grows to normal size in two to four weeks. By the summer of 2000, roughly 400 adult patients worldwide had received a "living donor" transplant.

CIRRHOSIS
Cirrhosis is the next disease stage after chronic hepatitis. Scar tissue replaces damaged liver cells, so blood can't flow as well through the liver. This kills even more cells, setting off a cascade of problems, including nausea, weight loss, jaundice, a tendency to bleed easily, fluid buildup in the stomach and ankles, confusion, cancer, and even coma. There may be no sign of cirrhosis until scars block veins and the backup pressure causes massive vomiting of blood-a serious warning of advanced cirrhosis.
Alcohol abuse and hepatitis C are the major causes of cirrhosis: One-third of people who take more than five drinks a day for 15 years, and about 30 percent of those with chronic C, get cirrhosis of the liver.
At this point, the damage can't be reversed-but treatment can slow or stop its progress once the cause is removed. Doctors may also be able to treat coma, fluid buildup, and bleeding, sometimes with surgery. Quitting all alcohol is a must.

LIVER TRANSPLANTS
In 1999, about 4,700 people in the United States received a liver transplant, the only treatment for liver failure.
Organ transplants have become more common in the last 20 years, with good quality of life afterward. Overall, 90 percent of children and 85 percent of adults survive surgery and the first year. Cost for the first year, including surgery and drugs, is $250,000 to $300,000 (covered by most insurers).
It's not a complete cure. Most people who get a transplant have to take drugs forever so their body doesn't reject the new organ, and the drugs have side effects. People with hepatitis B and C will reinfect the new liver, and a small percentage may face liver failure-and a transplant-again.

HEPATITIS EPIDEMIC
Viral hepatitis is a major public health problem, infecting hundreds of millions of people worldwide.
In the United States, one in three people has had the milder oral-type hepatitis A. Almost all recover and are immune. But about 4 million have the more dangerous blood-borne types B and C-and are carriers who can infect others.
Both B and C are spread through body fluids, much like the HIV virus that causes AIDS. In fact, hepatitis B is much more infectious than HIV-and more widespread (perhaps 900,000 Americans have HIV).

HELPING YOUR DOCTOR HELP YOU
 Talk first about what worries you most. Get straight to the point, so you won't miss your chance.
 Be specific. Don't just say, "I feel rotten." Describe symptoms as clearly as you can.
 Tell the truth. Your doctor needs to know what you really eat, how much you really exercise, and whether you drink, smoke, or use drugs. Everything you say is confidential.
 Ask questions. Bring a list to help you remember. If you hear any medical terms you don't understand, ask for translations.
 Get the facts about each new treatment. If your doctor suggests you have a test or see another doctor, ask why.
 Speak up. If something bothers you, say so. If you want a certain medication or procedure, ask whether it will work for you.
 If you cannot follow your doctor's advice, say so. Be willing to negotiate. If your doctor advises a treatment with side effects you find hard to accept, say something like, "I'd find that hard to live with. Is there another option I could try?"
 Don't leave what you've learned at the doctor's office. Write down what you want to remember or need to do.

MAKE SURE YOUR DOCTOR TELLS YOU...
 What kind of hepatitis you have
 How far your hepatitis has progressed.
 What the usual outcome is for that kind of hepatitis.
 What kinds of tests you have had and what other tests are suggested.
 Details of your treatment plan-and any possible side effects.
 Whether any medicine you're taking for something else might make your hepatitis worse.
 How contagious you are to family members and others.
 Whether those near you should be tested.
 What changes in diet or lifestyle you and your family might make.
 How you'll know you are getting better, or that your treatment plan is working.
 The next step for you and your doctor.