Viral Hepatitis

Inflammation of the liver is known as hepatitis. Sudden inflammation of the liver is known as acute hepatitis. If the liver remains inflamed for months or years, this is known as chronic (long-term) hepatitis.

Viral hepatitis is inflammation of the liver that’s due to a viral infection. It is is most commonly caused by hepatitis A, B, C, and E.

Types of viral hepatitis

Hepatitis A (HAV) and Hepatitis E (HAE)

These can be picked up in a number of ways. Most people get them by eating food or drinking water which has been contaminated with infected faeces as a result of poor hygiene or inadequate cooking. Less commonly, they can be transmitted through cuts in the skin or mucous membranes - sharing razor blades, toothbrushes, or needles if injecting drugs are common risk factors. Hepatitis A can be also passed on by having unprotected sex with a person who already has the virus, usually between men who have sex with men. The hepatitis caused by HAV and HEV is usually mild, and doesn’t require treatment, although hepatitis E can occasionally be serious in those with a weakened immune system. A vaccine is available to prevent hepatitis A - people with cirrhosis and those visiting developing countries should be vaccinated. There is not yet a commercially available vaccine for HEV. Find out more about hepatitis E here.

Hepatitis B (HBV)

Hepatitis B is the most common cause of viral hepatitis worldwide, due to either the infection being passed on from mother to baby at birth or becoming infected in early childhood. Sexual transmission and exposure to other body fluids are also common risk factors. In the UK, hepatitis B is most commonly transmitted through blood and other bodily fluids – sharing needles to inject drugs or having unprotected sex with someone who already has the virus, for instance. It’s not spread through food or water or ‘casual’ contact, such as holding hands, coughing or sneezing. A vaccine is available to prevent it.

Further info here: Hepatitis B - British Liver Trust

Hepatitis C (HCV)

This is passed on via contaminated blood. Common risk factors include sharing contaminated needles during intravenous drug use, sharing personal items contaminated with blood such as razors, or having unprotected sex with someone who already has the virus. It can be transmitted from mother to baby during birth. Previously people have been infected by blood products although these are now rigorously tested in the UK and are safe. Currently, there is no vaccine available but there are very effective treatments available for hepatitis C, so it’s important to get tested if you have ever been at risk.

Find out more about Hepatitis C

Hepatitis D (HDV)

You can only get hepatitis D if you already have hepatitis B, as hepatitis D needs the hepatitis B virus to survive in the body. It is usually spread through blood-to-blood contact or sexual contact. It’s possible to become infected with both hepatitis B and D at the same time, or to become infected with hepatitis D at a later date.

Having both hepatitis B and D is called co-infection, and chronic (long-term) infection with both increases the risk of developing serious liver diseases such as cirrhosis and liver cancer. If you have been diagnosed with hepatitis B you should be tested for hepatitis D with a separate blood test that looks specifically for anti-hepatitis D antibodies in your blood. If these are found, it means you have been exposed to the hepatitis D virus. There is no vaccine for hepatitis D but if you have been vaccinated against hepatitis B this also protects you from hepatitis D.

Find out more here: Hepatitis E - British Liver Trust

Left untreated, some types of viral hepatitis can badly damage the liver, causing scarring. This scar tissue is known as cirrhosis, and over time it can stop the liver from working properly. In severe cases, life-threatening conditions such as liver failure (where the liver loses most, or all, of its functions) or liver cancer can occur.

It’s very important to get tested if you think you may have come into contact with the infection because there are highly effective treatments available that can help prevent further damage to the liver. Speak to your GP, who can physically examine you and arrange a blood test to investigate further.

Symptoms of viral hepatitis

Common symptoms in the early stages of a viral hepatitis infection (also known as the ‘acute’ phase) include a high temperature, fatigue, mild abdominal pain, loss of appetite, jaundice (yellowing of the skin and eyes), nausea and vomiting. However, some people have no symptoms at all.

Patients with chronic (long term) HBV and HCV may not experience symptoms until their liver disease becomes severe, so it’s important to get tested if you think you might be at risk as there are highly effective treatments available.

Find out more

Further information

Public knowledge about hepatitis is slowly improving but there is still widespread ignorance about who gets hepatitis and how it’s passed on.

You may want to discuss your concerns with a health professional or counsellor who is trained to help you cope with a diagnosis of hepatitis and any social difficulties that may come with it, such as:

Insurance and mortgages

Most insurance companies will ask applicants if they have been tested for HIV, hepatitis B and hepatitis C. A positive test result may mean a life insurance policy or a mortgage linked to a life policy could be refused or the premium raised. If this happens, it is worth talking to your doctor as many consultants are willing to write to a mortgage or insurance company stating your health and life expectancy.

Who to tell

This is often a difficult decision but you should consider that a positive result may affect your family and sexual partner(s) and whether these people should also think about testing. If you are HBsAg positive, your partner will need vaccinating if they are negative. Vaccination will completely protect them. With a new partner it is important to use barrier contraceptives (condoms) until they have been vaccinated.

Confidentiality

You may want only certain people to know about your test and results. GUM (genito-urinary medicine) clinics offer a confidential testing service, although in the case of a positive result your GP will become involved when you are referred for ongoing care. Any doctor who diagnoses acute viral hepatitis is legally required to report this information to Public Health England to help reduce the spread of infection.