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There are 5 types of hepatitis - A, B, C, D, and E - each caused by a different hepatitis virus.  

Hepatitis A is caused by eating food and drinking water infected with a virus called HAV. It can also be caused by anal-oral contact during sex. While it can cause swelling and inflammation in the liver, it doesn't lead to chronic, or life long, disease.  Almost everyone who gets hepatitis A has a full recovery.

Hepatitis B is caused by the virus HBV.  It is spread by contact with an infected person's blood, semen, or other body fluid.  And, it is a sexually transmitted disease (STD). You can get hepatitis B by:

Having unprotected sex (not using a condom) with an infected person. 

Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs like vitamins and steroids).

Getting a tattoo or body piercing with dirty (unsterile) needles and tools that were used on someone else.

Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way).

Sharing a toothbrush, razor, or other personal items with an infected person.

An infected woman can give hepatitis B to her baby at birth or through her breast milk.

Through a bite from another person.

With hepatitis B, the liver also swells. Hepatitis B can be a serious infection that can cause liver damage, which may result in cancer. Some people are not able to get rid of the virus, which makes the infection chronic, or life long.  Blood banks test all donated blood for hepatitis B, greatly reducing the risk for getting the virus from blood transfusions or blood products.

Hepatitis C is caused by the virus HCV.  It is spread the same way as hepatitis B, through contact with an infected person's blood, semen, or body fluid - - - (see above). Like hepatitis B, hepatitis C causes swelling of the liver and can cause liver damage that can lead to cancer. Most people who have hepatitis C develop a chronic infection. This may lead to a scarring of the liver, called cirrhosis.  Blood banks test all donated blood for hepatitis C, greatly reducing the risk for getting the virus from blood transfusions or blood products.

Hepatitis D is caused by the virus HDV. You can only get hepatitis D if you are already infected with hepatitis B. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex (not using a condom) with a person infected with HDV. Hepatitis D causes swelling of the liver.

Hepatitis E is caused by the virus HEV.  - - You get hepatitis E by drinking water infected with the virus. This type of hepatitis doesn't often occur in the U.S.  It causes swelling of the liver, but no long-term damage. It can also be spread through oral-anal contact.


Definition:

The term "hepatitis" refers to syndromes or diseases causing liver inflammation, including inflammation due to viruses and chronic alcohol abuse. - - - -  Viruses causing hepatitis include Hepatitis A, B, C, E and the delta factor. - - - - Each virus causes a distinct syndrome, though they share some symptoms and  consequences.

Most people who become infected with hepatitis B get rid of the virus within 6 months. A short infection is known as an "acute" case of hepatitis B.

Approximately 10% of people infected with the hepatitis B virus develop a chronic, life-long infection.  People with chronic infection may have symptoms, but many of these patients never develop symptoms.  These patients are some-times referred to as "carriers" and can spread the disease to others.   Having chronic hepatitis B increases your chance of permanent liver damage, including cirrhosis - (scarring of the liver) and liver cancer.


Hepatitis B is transmitted via blood and other body fluids. Infection can occur through:

Contact with blood in healthcare settings -- this puts physicians, nurses, dentists, and other healthcare personnel at risk.

Unsafe sex with an infected person.

*  Blood transfusions.

*  Sharing needles during drug use.

Receiving a tattoo or acupuncture with contaminated instruments .

*  Birth -- an infected mother can transmit the virus to the baby during delivery or shortly thereafter.

* People who are at higher risk, including people who live with someone with hepatitis B and healthcare workers, should get the hepatitis B vaccine.

In acute hepatitis, it takes about 1 to 6 months from the time of infection until the disease manifests itself. Early symptoms may include nausea and vomiting, loss of appetite, fatigue, and muscle and joint aches. - - Jaundice, together with dark urine and light stools, follows.

About 1 percent of patients infected with hepatitis B die due to liver damage in this early stage.

The risk of becoming chronically infected depends on the age at the time of infection. More than 90% of newborns, about 50% of children, and less than 5% of adults infected with hepatitis B develop chronic hepatitis.

Most damage from hepatitis B virus is caused by the body's response to the infection.    - - - The body's immune response against the infected liver cells (hepatocytes) damages the cells, causing liver inflammation (hepatitis).   

As a result, liver enzymes (transaminases) leak out of the liver into the blood,  causing transaminase blood levels to be elevated. The virus impairs the liver's ability to produce the clotting factor prothrombin, increasing the time required for blood clot formation (prothrombin time).  

Liver damage also impairs the body's ability to rid itself of bilirubin (a break-down product of old red blood cells), causing jaundice (yellow discoloration of the eyes and body) and dark urine. 

Hepatitis B Virus


Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact.  It is seen with increased frequency among intravenous drug users who share needles and among the homosexual population.  - - - - - - - - - - - This photograph is an electronmicroscopic  image of hepatitis B virus particles. (Image courtesy of the Centers for Disease Control and Prevention.)

Digestive System


The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Agressive Hepatitis


Chronic active hepatitis is a liver disease caused by infection, drug ingestion, metabolic or autoimmune disorders.  Necrosis (death) of liver cells, inflammation and fibrosis may lead to liver failure. Death within 5 years of onset occurs in 40 to 50% of patients..

Gianotti-Crosti Syndrome On The Leg


Gianotti-Crosti disease is also called acrodermatitis of childhood. These red, elevated lesions do not contain pus and can occur on the limbs, buttocks, face, and neck.


Fulminant Hepatitis

- - - -  Fulminant hepatitis is a severe but very rare form of acute hepatitis, it may begin with fatigue and nausea, but within a few weeks the signs and symptoms are pronounced (see acute hepatitis signs and symptoms listed above). - - About 2 weeks after jaundice develops encephalopathy develops.

Encephalopathy is a state of impaired or altered mental status. In its mild form there may be some short term memory loss, forgetfulness, slurring of speech, small behavioral personality or behavioral changes, changes in sleep pattern.

- - - -In its severe form, severe loss of memory. not knowing the date, year, their name or address, confusion, inappropriate behavior, poor coordination, asterixis uncontrollable flapping of the hands, fetor hepaticus- foul smelling breath, and coma.Up to 85 per cent of people with this type of rare hepatitis will die without a liver transplant.


Blood Tests
Blood tests will show the presence of the disease and what is affected. A hepatitis B serology blood test will give an accurate diagnosis of the type of hepatitis present as there are different strains of the virus.

Blood Test-Liver Function Tests
These blood tests show how well the liver is functioning but it does not accurately access all of the many and varied functions that the liver is responsible for in our bodies. They do check the level of liver enzymes, transaminases and cholestatic enzymes, bilirubin and liver protein levels, all of which can be affected by the liver virus.

High levels of transaminases in the blood do not always reveal how badly the liver is inflamed or damaged. Elevations of them can also occur in genetic liver disease, liver tumours, heart failure. The normal ranges of AST and ALT transaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively. In chronic hepatitis B the levels are usually two to three times above the normal range.

Blood Test-Liver Proteins
Albumin, prothrombin, and immunoglobulins, proteins made by the liver are checked and abnormal levels are indicative of severe liver disorder.  Prothrombin times, because the liver produces many of the clotting factors required to stop bleeding, needs to be determined.

Liver Biopsy
Liver biopsy is one of the main and most accurate diagnostic procedures that can determine what is wrong with the liver and how badly it has been damag-ed. As most liver diseases affect the entire organ uniformly, the small sample obtained by biopsy, generally performed under a local anaesthetic, will show any abnormalities. For most people the guided liver biopsy is a safe and efficient diagnostic tool.


Acute hepatitis B is treated conservatively, rest and plenty of fluids. Bed rest is not needed by all people who have the virus, it just depends on how ill you feel. If you are up to it then there is no reason why you should not go to work. It is important to lead a healthy life, so stop smoking (try hard!), definitely give up alcohol for a few months as the liver needs time to recover, and eat a healthy diet.


For those people whose bodies are unable to clear the virus hepatitis B will go on to become a chronic condition. Not so long ago there was no treatment for hepatitis B, however there are now a number available that are proving very effective. The future is looking a lot brighter. Scientists and drug companies are hoping that within the next few years a treatment will be discovered that will offer a cure for everyone with chronic hepatitis B.


Treatment with antiviral therapy is available for people with chronic hepatitis B although it is not recommended for all infected individuals. Treatment is aimed at suppression of the hepatitis B virus and stopping active liver disease.  - - -The (Food and Drug Administration) has approved two drug types, alpha interferon and lamivudine. - - -   Alpha interferon, given by injection, stimulates the body’s immune system and is administered for 16 weeks. It is very expensive and does have a number of side effects, a few of them serious.

Lamivudine, taken orally for 52 weeks, although it has few side effects, is not as long lasting as interferon. ------- Relapse is a common feature and its use can lead to antiviral resistance.  Response rates to the drugs successful treatment programmes are variable.  The FDA reports (October 2002) that it is ‘above 50%   in patients with ALT levels greater than 5 times the upper normal limit of normals, but lower (20%-35%) in patients with ALT levels less than 2 times the upper limit of normal. In patients with ALT levels less than 2 times the upper limit of normal, response rates are poor and therapy should be deferred’.

A new drug type is offering a possible third option, the neucleotide analogue adeforir dipivoxil, Hepsera which is currently being evaluated.


Approximately 2 per cent of chronic hepatitis B sufferers each year go on to develop cirrhosis.

*  The cumulative probability over 5 years of developing cirrhosis is therefore 15 per cent to 20 per cent.

*  The 5 year survival rate after cirrhosis develops is between 52 per cent and 80 percent.

*   If decompensated cirrhosis (cirrhosis accompanied by complications such as bleeding and encephalopathy) develops, survival rates decrease to between 14 per cent and 32 per cent.

*  There is an increased risk of liver cancer. Worldwide about 1 million people a year die from the complications of Hepatitis B.

Those with a less favorable prognosis also include:

*  Those with poor general health..
*  People whose health systems are inadequate, lacking funds, unhygienic.
*  The elderly.
*  People infected with hepatitis D and hepatitis B
*  People infected with hepatitis C as well as hepatitis B.
*  Those who are diagnosed with advanced hepatitis when they come to the attention of doctors.
*  Those who continue to drink alcohol after a diagnosis of chronic hepatitis..

Additional problems of Hepatitis B and D

Hepatitis D can only exist with the hepatitis B virus and can be caught either at the same time as HBV (co-infection) this type is known to clear the body well (90% to 95%). Others get the HDV separately when they are already infected by HBV, (superinfection), here 70% to 95% go on to have the more serious chronic form of HDV.

Prevention

Hepatitis D is transmitted in the same way as Hepatitis B.

- - - -A vaccine is available and is advised for those at risk or in contact with the disease. The vaccine is 90-95% effective in preventing Hepatitis B and preventing the chronic form of the disease.  79% of World Health Organization members have adopted the universal childhood Hepatitis B vaccination policy.

Unfortunately the cost of the vaccination and the simple means of transmission of this virus mean that overall the incidence of hepatitis B continues to rise.

For people who know they are infected carriers of the hepatitis B virus they can take precautions so that they do not infect others.  - - These include the appropriate disposal of contaminated waste, separate toothbrush, scissors, never sharing needles and syringes with others, using condoms, avoiding anal intercourse. - If your job involves working in high risk areas you should consult your doctor for advice on precautions and any effects that it may have on your future health.   All people infected with hepatitis B should get a hepatitis A vaccine to prevent becoming infected.

 Remember you    
 haven't  been
 condemned to
   
 _____!  You may
feel like you have.
Never give up!!!

If you find out you have hepatitis B don't despair. - - Get a doctor specialising in hepatology to advise you on the best treatments and on how you can maximise your health to fight the virus. Remember you are not alone, there are millions of people with it. Find a local support group through the internet or find out what is available from your medical team that is providing your care.

Compiled and written by: Deborah Shrira RPH, CMA      --  8 November 2005

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