Hepatitis

Hepatitis

Defining Hepatitis

What is hepatitis?

Hepatitis is an inflammation of the liver, and has various underlying causes. Inflammation can worsen, and develop more severe conditions such as cirrhosis (irreversible scarring of the liver), fibrosis (a thickening and scarring of liver tissue) or liver cancer.

Viral infections are the more common culprits in causing hepatitis, but inflammation can also be brought on as a side-effect of illicit drug use, medications, excessive alcohol consumption and various toxins (known as toxic hepatitis). Typically, toxic hepatitis resolves itself when the underlying cause is removed. Complications will, however, depend on the nature of damage caused to the liver. When the body produces antibodies that work against the normal function of the liver, another cause can result in autoimmune hepatitis.

Illustration showing a healthy liver versus one affected by hepatitis

How does the liver function?

The liver is an essential organ for overall well-being and is located on the right upper quadrant of a person’s abdomen. The liver regulates the body’s metabolism levels which is vital for our overall health.

Some of the critical functions of the liver include filtering out toxins (and bilirubin, cholesterol and hormones) in the body, aiding bile production for comfortable digestion, metabolising proteins, carbohydrates and fats, activating enzymes, synthesising plasma, storing minerals, vitamins and glycogen, as well as the synthesis of clotting factors.

What are the main types and causes of hepatitis?

There are a variety of hepatitis types which directly relate to an underlying cause. Hepatitis types can be classified as viral and non-viral.

The main types of hepatitis are:

  • Hepatitis A (HAV): A viral type of the condition due to an infection with the hepatitis A virus (HAV). Highly contagious, hepatitis A infections are typically acute (short-term) but capable of being transmitted through contaminated food or water (water may be contaminated with faeces). HAV can also be contracted via direct contact with faeces. Hepatitis A is generally not considered too serious an infection as it typically doesn’t result in any long-term complications. Hepatitis A can resolve (clear up) on its own.
  • Hepatitis B (HBV): This viral form of the condition occurs as a result of an infection with the hepatitis B virus (HBV). The condition is also contagious and easily spread through direct contact with the bodily fluids of an infected person (saliva, urine, blood or semen). Those at an increased risk of an HBV infection typically share needles (usually when engaging in illicit drug use), have unprotected sex or even share razors. HBV can also happen during childbirth, being passed on from mother to new-born baby. HBV can become a chronic infection (the infection develops gradually) with symptoms only showing when complications develop. In acute instances, symptoms develop quickly. A person infected with HBV can still be contagious even without the presence of symptoms. The virus can also live outside the body, sometimes for up to 7 days.
  • Hepatitis C (HCV): This refers to an infection with the hepatitis C virus (HCV), this type is also highly contagious, and easily transmitted through direct contact with the bodily fluids of an infected individual (i.e. it is often sexually transmitted). HCV can also be classified as either acute (symptoms develop quickly and last for several weeks) or chronic (symptoms develop gradually within several months).
  • Hepatitis D (HDV): An infection with the hepatitis D virus (HDV) is a rare form of the condition that often occurs in conjunction with a HBV infection. Hepatitis D is not typically contracted on its own and commonly develops in a person already infected with hepatitis B. HDV is typically contracted through exposure to infected blood. The virus is prevalent in Central Asia, West Africa, South America, the Pacific islands, the Mediterranean and Russia. An infection that develops slowly and lasts more than 6 months is classified as chronic, and typically increases a person’s risk for further complications such as cirrhosis of the liver. Acute infections develop symptoms quickly which tend to be more severe.
  • Hepatitis E (HEV): Infection with the hepatitis E virus (HEV) typically occurs in areas with poor sanitation (common in developing countries) and where exposure to contaminated water is high. Faecal matter is commonly ingested causing a serious acute infection. An infection can clear up on its own, but it can also worsen and cause complications such as acute liver failure.

Hepatitis can also have a non-viral cause. This includes:

  • Autoimmune diseases: The liver may come under attack from the body, particularly the immune system. Normally, the body’s immune system operates as a protective means against illness and infection (viruses, bacteria and pathogens). When there is an impairment in this function, the immune system works against the natural flow of protection and instead attacks its own tissues and cells. A complication of this is when the immune system ‘regards’ the liver as a ‘harmful object’ in the body and works against it, hindering its normal function. This can result in inflammation and damage, causing non-contagious hepatitis. There are two classifications of autoimmune hepatitis – Type 1 autoimmune hepatitis (which affects people of all ages and gender) and Type 2 autoimmune hepatitis (which is less common and usually affects girls and young women).
  • Alcohol-related: Excessive alcohol consumption over prolonged periods can result in damage to the liver. The knock-on effect of this can result in hepatitis, often referred to as ‘alcoholic hepatitis’. Alcohol aggravates the liver and causes swelling. In the process of breaking down alcohol in the system, the body retains toxic chemicals which trigger inflammation. This leads to scarring, which compromises the normal healthy function of the liver, leading to hepatitis symptoms. Medication overuse and exposure to poisonous chemicals can have a similar effect on the liver, causing toxic hepatitis. Heavy drinkers are also often malnourished. A lack of nutrients in the body combined with alcohol by-products which aren’t properly absorbed ultimately result in liver cell damage. In this instance, hepatitis is not caused by a virus and is thus not contagious.

How is viral hepatitis spread?

  • Hepatitis A: HAV is typically contracted from ingested food or liquid (water) that is contaminated with infected faecal matter. The infection spreads to the liver through the bloodstream once ingested and causes swelling and inflammation. An infected person can transmit the disease through close personal contact with others. Hepatitis A then becomes contagious to others through eating foodstuffs and drinking fluids handled by an infected person (who may not have strict hygiene habits after using the toilet), having unprotected sex with someone with the virus, having direct contact with infected faecal matter or eating sewage-contaminated foods (such as raw or undercooked seafood) or those washed with untreated tap water. An infected person will likely be contagious for a period of at least 2 weeks (often before obvious symptoms even develop) and until at least 1 week after noticeable signs develop. Those handling children in nursery care centres or frail care centres for the aged will need to take care if handling nappies (diapers) of young children and elderly residents. Hygiene habits (regular hand-washing) are essential to curb the spread of potential infections.
  • Hepatitis B: HBV is highly contagious and transmitted through direct contact with infected bodily fluids (fresh or dried). The virus is detectable in saliva, but is not easily transmitted through contact with the substance (sharing utensils or kissing an infected individual). HBV is also not easily spread through coughing, sneezing and even breastfeeding. Symptoms may develop over a period of 3 months (incubation period) but once evident can last for between 2 and 12 weeks. An infected person is still highly contagious even without the presence of symptoms. HBV is easily contracted through direct handling of infected blood (health care workers are at risk of infection through cuts in the skin or exposed contact in the eyes or mouth), intimate relations (unprotected oral, vaginal or anal sex), sharing a razor or other personal items containing remnants of infected bodily fluids (particularly blood), sharing needles or cottons, spoons or water used for injecting illicit drugs or during a tattoo or body piercing process, and through childbirth (during which a baby comes into contact with an infected mother’s bodily fluids). Blood transfusions and organ transplants can also be high risk for spreading hepatitis B (this is less common – since approximately 1992 - if all donated blood and organs are carefully screened). Acute infections are short-lived (less than 6 months) and the body (immune system) typically clears HBV with a full recovery. An acute infection can become chronic, however, if the immune system produces an antibody to help fight the condition, the infected person won’t likely be contagious after the incubation period. A chronic infection lasts beyond 6 months when the immune system is unable to produce antibodies to fight off an acute case of HBV. Chronic cases can last a lifetime and lead to long-term damage of the liver. For as long as they have an active infection, long-term sufferers can spread the virus. Chronic infections are highest among new-borns and young children under 5 years of age.
  • Hepatitis C: HCV is highly contagious once transmitted through direct contact with contaminated blood. The disease is less commonly spread through sexual contact (but this can happen if you have multiple partners). Common transmission means include the sharing of personal care items that may have remnants of infected blood (such as razors and even toothbrushes or nail clippers), direct contact with contaminated blood (including during organ transplants and blood transfusions, particular before 1992 when blood wasn’t typically screened for hepatitis C), sharing of needles used for illicit drug use, tattooing or body piercing and childbirth. Other high risk factors for transmission include those who have received haemodialysis treatment (a renal replacement therapy) or clotting factor concentrates and similar blood products (more common before 1987). Contracting the virus is less common from casual contact (sneezing, coughing, sharing foodstuffs and water, or kissing an infected person). Blood contact is the primary means of transmission for HCV.
  • Hepatitis D: Direct contact with the bodily fluids (vaginal fluids, semen, urine and blood) of an infected person transmits the disease. Childbirth is another way HDV is transmitted. Hepatitis D typically develops once a person has contracted the hepatitis B virus. As with the other viral variations of the disease, an infected person is contagious even before symptoms develop.
  • Hepatitis E: Poor sanitation combined with overcrowded living conditions (typical of developing countries) easily contributes to the spread of hepatitis E infections. Ingested water and foodstuffs contaminated through exposure to faecal matter is the primary cause of HEV. It is rare, but it can happen that HEV is transmitted by consuming products from an infected animal or blood transfusions. Transmission has also been noted from mother to child during childbirth. Most HEV infections clear up on their own within a few weeks. If an infection is not able to clear, it can worsen, causing further damage to the liver and can ultimately cause total failure.

How does hepatitis affect the body?

Typically, symptoms for all types of hepatitis occur once the infection begins causing damage to the liver. In acute cases, symptoms develop quickly and in chronic instances, signs may take up to 6 months to begin showing concern.

General signs and symptoms for acute and chronic hepatitis

All hepatitis types will have the following signs and symptoms in common:

Young woman with abdominal discomfort

Other signs and symptoms for hepatitis A (between 15 and 50 days following contact with the virus)

  • Nausea
  • Vomiting
  • Extreme fatigue
  • Muscle aches
  • Clay-coloured stools (bowel movements)

Other signs and symptoms for hepatitis B and D (between 1 and 4 months following contact with the virus)

  • Abdominal discomfort
  • Joint pain
  • Body weakness
  • Headache
  • Tan-coloured stools (bowel movements)

All symptom for hepatitis B must be assessed and treated by a medical professional as quickly as possible to prevent an infection developing into HDV and further health complications. If you are exposed to the virus and can seek treatment within the first 24 hours following exposure, an infection can be prevented with prompt medical attention.

A HDV infection may not always display obvious symptoms but when they do, they are very similar to those of hepatitis B. Symptoms of HDV can often make those of HBV worse, which can make diagnosis a little trickier.

Other signs and symptoms for hepatitis C (between 2 weeks and 6 months following contact with the virus)

  • Abdominal discomfort
  • Joint pain
  • Itching skin
  • Nausea

If there are already signs of damage to your liver, you will display the following symptoms:

  • Redness / tenderness on the palms of your hands
  • Spider angiomas - Clusters of ‘tiny red spiders’ (blood vessels just beneath the skin) – usually on the face, shoulders and chest areas
  • Swelling in the feet, legs and abdominal area (belly)
  • Fluid build-up in the abdomen (ascites)
  • Muscle shrinkage
  • Bleeding in the digestive tract (variceal bleeding)
  • Hepatic encephalopathy (damage to the brain and nervous system) – confusion, concentration problems, slurred speech, drowsiness and memory lapses.

Other signs and symptoms for hepatitis E (within a few weeks following contact with the virus)

  • Liver enlargement
  • Acute liver failure
  • Nausea and vomiting

Non-viral hepatitis signs and symptoms

  • Alcoholic hepatitis: Common symptoms include jaundice, nausea and vomiting, loss of appetite, a low fever, abdominal tenderness or discomfort, body weakness, fatigue and unexplained weight loss (due to malnourishment and high calorie intake from alcohol consumption). In severe cases, common symptoms include ascites, kidney and liver failure, behavioural changes and confusion.
  • Autoimmune hepatitis: The most typical symptoms include fatigue, jaundice, an enlarged liver, abdominal discomfort and tenderness, spider angiomas and skin rashes, joint pain, and menstruation loss (in females).

Diagnosing hepatitis

A consultation with a primary health care provider (general practitioner / GP) will begin with a short discussion to determine a few things about your overall symptoms and medical history.

Your doctor may likely ask you questions such as:

  • When did you first notice your symptoms?
  • Would you describe your symptoms as occasional or continuous?
  • Would you describe your symptoms as mild or severe?
  • Have you tried anything that has either alleviated any symptoms?
  • Is there anything you’ve noticed has appeared to worsen your symptoms?
  • Are you currently taking any medications or supplements? (*This is important as it can affect any tests performed as well as their results)

Liver function test (blood sample for examination in a laboratory)

The general diagnosis procedure will then follow the below steps:

  • A physical examination: Your doctor will ask you to lay down on an examination bed and gently press down on your abdomen (tummy area). He or she will be looking for any signs (mild or severe) of discomfort, tenderness and pain. Your doctor will also look for signs of an enlarged liver (indicating damage and inflammation) and assess the colour of your skin and the whites of your eyes (possible jaundice).
  • Blood and liver function tests: Your doctor may recommend blood tests to assess the presence of a hepatitis virus (A, B, C, D and E). He or she will be testing for antibodies and antigens (toxins or foreign substances) in the blood that will typically indicate the presence of a virus (these will be higher if you currently have an infection or have had a hepatitis infection before – antibodies can stay in your blood permanently to fight off potential infections down the line), and underlying cause of a hepatitis infection. Blood samples will also be used to test the function of your liver and measure how effectively it is currently working. The test analyses whether the liver is clearing (metabolising) any blood waste, enzymes and proteins not needed for the body to function. If enzyme levels are high, it is an indication that the liver is inflamed and being damaged as a result. A blood sample will be taken from a vein in your arm. The test typically takes a few minutes to perform.
  • Viral antibody tests: These tests (a blood sample) can be used to determine the type of hepatitis virus present in the system or rule out a non-viral cause. These tests are also used to screen individuals with a higher risk of infection or transmitting an infection, such as nurses, doctors and dentists, as well as organ and blood donors.
  • Imaging tests: An abdominal ultrasound can give your doctor detailed images of the organs inside your abdomen. Your doctor can use an ultrasound to determine whether you have a build-up of fluid in your abdomen, which is often an indication of an enlarged liver (due to inflammation and damage).
  • Invasive testing: Your doctor will consider an invasive method of testing if it is determined that you have an infection and presence of inflammation that is causing damage to your liver. A liver biopsy is a closed procedure that involves a doctor removing a sample of liver tissue through the skin with a needle. Testing will assess the nature of the damage, which in turn will help to determine a final diagnosis and appropriate treatment plan.

If hepatitis B is suspected, your doctor may recommend the following blood test screenings:

  • Hepatitis B surface antigen test: This blood sample will help your doctor determine whether or not you are contagious. Positive results indicate not only a HBV infection, but also your capability of transmitting the disease. Negative results will indicate the lack of an infection present in the body. Your doctor won’t be able to use this test to determine acute or chronic variations of HBV.
  • Hepatitis B core antigen test: Positive results from this sample will indicate an HBV infection, as well as whether you have an acute or chronic variation of the disease.
  • Hepatitis B surface antibody test: This test will assess whether you have immunity to HBV. A positive result will indicate that you are immune to hepatitis B (you have either been vaccinated against the virus causing the disease or you have already recovered from an acute infection and are no longer contagious).

Other tests that may be recommended to assess liver damage and diagnose hepatitis (particularly chronic hepatitis) are:

  • MRE (Magnetic Resonance Elastography): If available, a doctor may opt for a non-invasive alternative to a liver biopsy. MRE technology looks at patterns formed when sound waves bounce off the liver and create a visual map of the organ. Your doctor will be able to see gradients of rigidity throughout the organ. A liver which is quite stiff (or rigid) may indicate scarring damage (fibrosis) as a result of chronic hepatitis.
  • Transient elastography: Also a non-invasive procedure, this type of ultrasound can also be used, when available to your doctor as an alternative to a biopsy. He or she will perform the imaging test to transmit vibrations to the liver and measure the dispersal speed through the organ in order to estimate its level of rigidity.

Both tests are completely painless to experience and results can be analysed fairly quickly.

Diagnosis for non-viral hepatitis:

  • Alcoholic hepatitis: Along with a physical exam, your doctor may wish to discuss your alcohol consumption history in detail. It is important to honestly disclose information about your drinking habits so that your doctor can make the best assessment for diagnosis, and ultimately the best course of action for treatment. Tests may include blood and liver function tests, imaging tests (ultrasound, MRI and CT scan) of your liver and if necessary, a liver biopsy.
  • Autoimmune hepatitis: A diagnosis will involve blood tests to rule out any potential viral causes (testing for antibodies) or other conditions that may have similar symptoms. The blood tests will also help your doctor to determine which autoimmune hepatitis type you have. A liver biopsy may also be recommended to confirm a diagnosis, as well as an ultrasound.

Testing and treatment procedures

Once your doctor has determined the presence of a hepatitis infection, as well as from which virus type you have contracted, the condition and whether it is acute or chronic in nature, an effective treatment plan can begin.

  • Hepatitis A: Typically, this type of hepatitis isn’t treated. If your symptoms are causing you a great deal of discomfort or you feel weak and lethargic, your doctor will recommend bed rest. Your doctor may encourage you to make changes in your normal diet if you are experiencing any symptoms of diarrhoea and vomiting, so as to prevent dehydration and possible malnutrition. If you are struggling to eat and experiencing nausea, you may need to try snacking on various foodstuffs instead of trying to consume large meals. High-calorie foods and liquids such as juice and milk will be more nourishing if you can stomach them. Your liver will do most of the work for you in this instance and clear your system of the HAV on its own. Your liver will likely heal completely within 6 months. It isn’t likely that you will experience any lasting damage. You will be discouraged from drinking any alcohol. If you need any medications, your doctor will carefully prescribe these for you. You should not take anything your doctor hasn’t recommended as your liver will have difficulty coping with many drug substances.
  • Hepatitis B: Acute conditions may be treated with antiviral medications for several months (and even years if necessary), but typically don’t require much treatment. Your doctor will recommend the same rest and nutrition home care as for HAV while the body works the virus out of its system. Chronic HBV will require regular medical evaluations and consultations to monitor the virus progression. Chronic infections will be treated with medical means to reduce the risk of liver disease and prevent further transmission of the disease. Along with antiviral medications (to fight the virus, reducing the possibility of further liver damage), other treatment involves interferon alfa-2b (Intron A) given as an injection, or a liver transplant (where severe damage is assessed).
  • Hepatitis C: Both acute and chronic HCV are treated with antiviral medications. Chronic conditions are treated with a combination of antiviral therapies. Medicinal treatment will depend on the hepatitis C genotype (genetic make-up of a cell), the extent of liver damage, any other health conditions and concerns and prior treatments. Medications prescribed will carry side-effects and these will be carefully monitored by your doctor. Your doctor may also recommend bed rest, a healthy diet and plenty of fluids as well. If necessary, your doctor may recommend follow-up liver function tests. A liver transplant is also considered where excessive damage is evident (cirrhosis or liver disease). A liver transplant isn’t necessarily a cure for hepatitis C, as the infection can recur. If the infection returns, you will need to take antiviral medications again to reduce the risk of further liver tissue damage.
  • Hepatitis D: Your doctor may prescribe large doses of interferon alfa-2b (Intron A) injections for up to 12 months. This medication prevents the virus from spreading and causing further damage to the liver. You may go into ‘remission’ but can experience recurring symptoms following treatment. You will be encouraged to take precautionary measures to prevent any potential to spread the disease (when active once again). Extensive damage and cirrhosis may require a liver transplant.
  • Hepatitis E: If an infection is acute, treatment may not be recommended and you will be advised to rest, adjust your overall diet and drink plenty of fluids (not alcohol). In some instances, medication (ribavirin) may be prescribed to help improve liver function. This medication will not be prescribed for pregnant women. If you are pregnant, have a suppressed immune system or show any signs of acute liver failure, your doctor may recommend that you are hospitalised and carefully monitored.
  • Non-viral hepatitis: If the underlying cause is determined as alcoholic hepatitis your doctor will immediately recommend drinking cessation (stop all alcohol consumption) to prevent further damage to the liver. Other treatment recommendations may involve medications (corticosteroids and anti-inflammatories), support groups and counselling, diet plans to correct any nutritional issues or tube feeding (if you have trouble being able to eat), or a liver transplant. Autoimmune hepatitis as an underlying cause is somewhat tricky to treat. Your doctor will use medications to reduce the progression of the disease and lower your immune-system activity. Medications and their doses will be carefully controlled as many will have side-effects which will also need to be managed. If medications aren’t successful in halting the progress of the hepatitis infection and damage caused to the liver becomes irreversible, the last remaining option a doctor will recommend is a liver transplant.

Risk factors and potential complications

What are the main risk factors for hepatitis?

  • Hepatitis A: If you travel to or live in areas with high infection rates, have unprotected sex with multiple partners, work in child care centres or nurseries and handle children, are HIV positive, use injected drug substances (intravenously i.e. injected into your vein), have a clotting-factor disorder (such as haemophilia), or have direct contact with an infected individual (that you live with).
  • Hepatitis B: You may be high risk if you have multiple sex partners (with whom you have unprotected sex), are a healthcare worker, use IV drug substances, have a chronic liver disease or kidney disease, or if you travel or live in high infection rate areas.
  • Hepatitis C: Risk is higher if you received a blood transfusion or had an organ transplant before 1992, were born to an infected mother, have had unprotected sex with an infected person, shared contaminated needles (when using illicit drugs, having body piercings or tattoos), are a healthcare worker exposed to infected blood, have HIV, received clotting factor concentrates before 1987, received haemodialysis (for an extensive period of time) or were ever imprisoned (this increases the risk of infection due to the sharing of personal care items between inmates).
  • Hepatitis D: You may be at increased risk if you have an HBV infection already, often receive blood transfusions, have unprotected sex or use IV drug substances.
  • Hepatitis E: Risk is higher in areas with frequent water contamination (especially resource – limited / developing countries or those affected by war, refugee camps and internally displaced populations).
  • Alcoholic hepatitis: Heavy drinking (or binge drinking), weight (obesity), a person’s sex (females have a higher risk due to the way alcohol is processed in the body), some genetic and environmental factors and race or ethnicity (African-Americans and Hispanic people are higher risk).
  • Autoimmune hepatitis: If you have a history of infections with measles, herpes (herpes simplex virus 1 and 2) or Epstein-Barr virus, if you are female (occurrence rates are higher in females than males), if you have a predisposition to autoimmune hepatitis (may run in families), have an autoimmune disease (such as celiac disease, hyperthyroidism or rheumatoid arthritis).

Illustration of a healthy liver versus extensive damage caused (cirrhosis)

What types of complications are common with hepatitis infections?

Acute hepatitis generally doesn’t lead to any long-term concerns. Chronic HBV and HCV commonly lead to more serious complications if damage is caused to the liver. Complications can include cirrhosis, acute and chronic liver disease, and cancer of the liver.

Liver failure is another complication which results in a build-up of fluid in the abdomen, bleeding disorders, kidney failure, increased blood pressure in the liver’s portal veins, hepatic encephalopathy and hepatocellular carcinoma (a form of liver cancer). If this happens you will be hospitalised and monitored very carefully.

A viral infection that isn’t well managed can lead to further damage to the liver and total failure. A medical professional will strongly advise you to avoid alcohol consumption, certain supplements and specific prescription and over-the-counter medications that will have an adverse effect on the liver.

Complications for alcoholic and autoimmune hepatitis can include varices (enlarged veins restricting blood flow and causing bleeding), high blood pressure in the liver (restricted blood-flow can lead to scarring and increased pressure in the portal vein), ascites, jaundice, hepatic encephalopathy, cirrhosis and kidney failure. Autoimmune hepatitis can also result in liver failure and liver cancer.

Hepatitis and pregnancy – what happens?

One of the most common questions for any pregnant woman when she has a medical condition is ...

“How will this illness affect my growing baby?”

Young woman feeling unwell during pregnancyA woman’s pregnancy itself shouldn’t cause any major concerns or aggravate hepatitis symptoms. The nature of hepatitis will determine effects on the body and a growing baby. Not all types of hepatitis will have a disastrous effect on a developing foetus. All cases, however, must be monitored and treated by a medical professional.

  • Hepatitis A: A doctor will recommend that a pregnant woman rest at home and adjust her diet to help her body heal on its own, clearing the virus. She should be clear of the virus within 1 to 2 months. An infection can affect a baby, but is typically mild and rarely happens. A baby shouldn’t experience any life-long complications once recovered should an infection occur. There are risks associated with the condition which can include placental abruption, premature uterine contractions and premature rupture of uterine membranes. This places a woman at risk of premature labour. Any and all risks should be carefully monitored.
  • Hepatitis B, C, D and E: Transmission from mother to child during birth occurs when the new-born child is exposed to infected blood and fluids during the delivery process. A positive hepatitis B diagnosis during pregnancy will be treated with hepatitis B immune globulin (during pregnancy, as well as during the delivery). Treatment is not a guaranteed preventative measure, but can help to reduce the transmission rate. A new mother will also be given a hepatitis B vaccine at 1 week, 1 month and 6 months following the birth of her baby, reducing the risk of the baby developing an infection. In many countries, a new-born is likely to receive a hepatitis B vaccination as well.

No matter the type of hepatitis infection, a woman will be required to have frequent liver function tests during her pregnancy and the results will be monitored by a medical professional.

If a woman’s liver is already severely damaged, the additional demands that pregnancy places on the organ can lead to complications of acute fatty liver (associated with liver disease). When there is a deficiency in the enzymes usually produced in the liver, a pregnant woman’s body isn’t able to sufficiently metabolise fatty acids. This can escalate quickly and become quite serious, affecting the unborn baby, whereby he or she may be born with the same deficiency.

If a pregnant woman is diagnosed with an acute fatty liver, a doctor may recommend a quick delivery if the mother is near to full term. Both mother and child will be hospitalised and treated in intensive care. A mother should recover quickly following the birth, depending on how severe the damage to her liver is in the first place. A baby will be carefully monitored and treated.

A pregnant woman can also develop gallstones due to her hepatitis infection. One of the first indications her liver is taking strain due to the illness may be symptoms of jaundice. A woman’s gallbladder typically empties at a slower pace during pregnancy.

Bile and bile salts remain in the system for longer, increasing a woman’s risk for the development of gallstones. If this is determined within the first 6 months of pregnancy, a doctor may be able to perform a laparoscopic procedure (a less invasive surgery with minimal trauma to the body and a faster recovery rate) to remove the gallstones. The final trimester is tricky as the uterus is too enlarged for the procedure to be done.

Can hepatitis be prevented?

One of the best means to avoid contracting hepatitis, particularly the viral types, is by practicing good hygiene. Particularly in areas where infection rates are high, you should be wary of drinking unbottled water and eating ice, as well as consuming raw fruits and vegetable or seafood.

Hepatitis that is transmitted through blood places risk associated with sharing needles for drug use, as well as body piercings and tattoos. You should be mindful of this, no matter where you are in the world. Sharing personal hygiene products such as razors and toothbrushes should also be avoided. If you come into contact with spilled blood, you should be mindful of touching this as well. It will also be recommended that you take extra precaution when it comes to your sexual activity which may put you an increased risk.

There are vaccinations available for preventing hepatitis A and hepatitis B infections. Vaccines for hepatitis C, D and E are still in development and aren’t yet safely available for the public. In areas where vaccines are given or highly recommended, they are administered as 2 shots for hepatitis A and as a series of 3 shots for hepatitis B. There are no known directly related serious side effects with either of these vaccines.

Nurse prepares a hepatitis A vaccine for injection

What is hepatitis C viral load?

Viral load refers to the amount of virus present in your bloodstream at any given time. Blood tests (specifically a HCV RNA qualitative test) will be used to determine this amount, as well as distinguish between a previous infection from an active one.

A doctor may recommend a third test, known as viral genotyping, to determine the specific virus in the body. This is especially important when it comes to diagnosis and recommending treatment.

In some instances, a higher viral load may determine the severity of your illness. This is not always strictly true for hepatitis C infections. The severity is determined by the nature of damage to your liver. Viral load is, however, an important indication of how well your treatment plan is likely to work. A doctor will still test your viral load, even during treatment, as a measure of treatment progress. A reduced viral load can indicate to your doctor that your course of treatment is getting the better of the viral infection.

Viral load testing typically doesn’t give your doctor detailed information about your symptoms or if your liver is functioning as it should. Liver function tests or a biopsy will shed relevant light in this instance and combined with your viral load results, will help determine the best course of action for your treatment.

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