A now world-wide outbreak of hepatitis ‘that began in fall 2021 among young children, sickening hundreds, continues nearly eight months later, as of May 2022. The medical community is searching for its cause.
Some researchers believe it may have been triggered by COVID-19 infections or by colds or other viruses. The challenge is that the term hepatitis denotes an inflammation of the liver, but in order to treat it, a doctor needs to know what caused that inflammation. That’s problematic, because a doctor must know the cause to treat it effectively.
Here’s what you need to know about the many types of hepatitis, their treatments and side effects.
What Is Hepatitis?
“I like to tell my patients, ‘The liver is angry for some reason,” says Anne Boone, PhD, a gastroenterological nurse practitioner at Cone Health Medical Group. There are a variety of subtypes of hepatitis, including drug-induced hepatitis, alcoholic hepatitis, autoimmune hepatitis and viral hepatitis, such as hepatitis A, B, C, D and E. While each type of hepatitis often has similar symptoms, they have their own unique causes and treatments.
Symptoms of hepatitis include:
· Jaundice (yellowing of the eyes or skin)
· Skin rashes
· Joint pain
· Abdominal discomfort
Diagnoses and Causes of Hepatitis
The first sign of hepatitis usually shows up on a generic liver function test or a complete blood panel, which tests the blood for compounds present. These are tests commonly done by your primary healthcare provider. If there are signs of liver damage, such as elevated liver enzymes, you may need to undergo further testing to determine whether your hepatitis is caused by a virus, an autoimmune disease, alcohol use or prescription drugs.
Drugs and supplements are metabolized through your liver. Sometimes, certain drugs or combinations of substances can overtax your liver, causing drug-induced hepatitis. Taking statins or St. John’s wort or both are two of the more common culprits, but Boone says many drugs can cause the disease. You can look up the drugs you’re prescribed and read about how likely it is to harm your liver on the LiverTox Database.
Like many drugs and supplements, alcohol is metabolized in the liver. As this happens, the liver releases chemicals that can inflame and scar the liver. While heavier drinking raises risk, even moderate drinkers can develop alcoholic hepatitis.
Autoimmune diseases are disorders, such as Celiac disease, multiple sclerosis, Type 1 diabetes, rheumatoid arthritis and Grave’s disease, a condition in which the cells that normally attack pathogens like viruses and bacteria, instead, attack your body’s own healthy cells. In some cases, your immune system can attack your liver. Scientists don’t know precisely what triggers autoimmune hepatitis, but it is more common in those who are already diagnosed with another autoimmune disorder.
Hepatitis A (HAV) is caused by a virus transmitted by blood and feces. Sometimes, you can contract the disease if you consume contaminated water or food, explains Boone. There is a vaccine that can prevent illness.
Hepatitis B (HBV) is caused by a virus that can be transmitted through infected bodily fluids, including blood and semen. Scenarios of infection include sexual contact, sharing of needles and syringes, accidental needle sticks and transmission from an infected mother to child during pregnancy. Hepatitis B can be acute or chronic.
While many of its symptoms, such as jaundice and abdominal pain, are the same as for other types of hepatitis, Boone explains, “In severe cases, you might have mental status changes [such as anxiety and depression] and confusion.” If your symptoms are as serious as those, seek treatment to avoid liver failure.
A vaccine also exists to protect against hepatitis B.
Patient experience: Michelle, a patient who shared her story with hepb.org had no idea she likely had chronic hepatitis B. Her own mother had transmitted the disease to Michelle during birth. She hadn’t experienced symptoms and was diagnosed only during her own pregnancy when her doctor ran a routine test. Luckily, the knowledge gave her and her medical team the wherewithal to protect her infant from the disease. Hospital staff took the extra precautions, by vaccinating Michelle’s child within 12 hours of birth. Michelle still has to manage her own disease, but her daughter is free of the infection.
Hepatitis C (HCV) “is one of those silent hepatitis situations,” says Boone. It’s usually found through screening, years after someone contracted it. “You may not have any signs or symptoms of it,” she says, even if it causes inflammation or scarring of the liver. The virus is transmitted through the blood. Like hepatitis B, it can be acute or chronic. The infection can be serious and lead to severe liver damage or liver cancer.
Boone warns that many people don’t realize you can be infected with hepatitis C more than once, because there are many different disease variations.
Hepatitis D (HDV), which is spread by bodily fluids, only infects people who are currently or who were already infected with hepatitis B. It can be either acute or chronic. Chronic hepatitis D infection damages the liver more rapidly than hepatitis B alone. Diagnosing hepatitis D requires a blood test for virus-specific antibodies. Since you cannot contract hepatitis D without hepatitis B, the hepatitis B vaccination can prevent both illnesses.
Hepatitis E (HEV) can cause either acute or chronic disease, but it’s less likely to become chronic than other variations of viral hepatitis. In the rare instance that it does become chronic, it’s usually in people who are taking powerful immunosuppressant drugs, such as those who have received a solid organ transplant, including a kidney, liver, intestines, heart, lung and pancreas.
Hepatitis Treatment and Side Effects
No treatments exist for hepatitis A, though most people do recover on their own after a few months. If your symptoms are severe, you may be admitted to a hospital, but the treatment would be only for supportive care, explains Boone. For example, while your body is healing, you might receive intravenous fluids to help you stay hydrated and antiemetic drugs, such as Reglan (metoclopramide), to lessen nausea. The drug bears a warning, saying that it can cause tardive dyskinesia, a potentially irreversible, movement disorder.
If your symptoms of hepatitis B are not severe, your healthcare provider will “usually wait and let it ride its course, because the patient might clear the virus on their own,” says Boone. However, there are situations in which you will need treatment. If, for example, after several months, the infection is still present, you might be prescribed an antiviral medication, such as Baraclude (entecavir), Epivir (lamivudine), Hepsera (adefovir), Tyzeka (telbivudine) or Viread (tenofovir).
With any of these drugs, your healthcare provider must closely monitor you by ordering regular blood tests, says Boone, because they can cause anemia or kidney dysfunction.
Entecavir, lamivudine, and tenofovir can cause lactic acidosis, a potentially fatal buildup of acid in the blood, and further damage the liver.
At first, you likely receive supportive care such as intravenous fluids while your body fights the virus on its own, but if you don’t clear the virus after about six months, you may be prescribed antiviral medicines.
- Zepatier (elbasvir/grazoprevir)
- Mayret (glecaprevir/pibrentasvir)
- Harvoni (sofosbuvir/ledipasvir)
- Epclusa (sofosbuvir/velpatasvir)
Boone says that with hepatitis C antivirals, she often sees patients complain of fatigue, headaches or insomnia. “A lot of times, it gets better as the treatment continues,” she says, “because hepatitis C is being eradicated.”
If you’re experiencing headaches, she says it’s okay to take Tylenol [acetaminophen], but you need to be careful with the dose. “If you don’t have a liver disease, then four grams in a 24- hour period is your max.” To be safe, Boone says, if you have hepatitis, you shouldn’t take more than two grams in a 24-hour period. That’s because your liver is less capable of metabolizing the drug, so it stays in your body longer and can have a cumulative ill effect.
You’ll need care for the Hepatitis B, plus you may be prescribed interferon, which you may have to take for up to a year. Interferon drugs are man-made proteins that mimic proteins in our immune systems that fight viruses. The main side effects are flu-like symptoms, injection site reactions, insomnia and gastrointestinal effects.
You need a steroid treatment, and in some cases, you may also be prescribed another medication azathioprine. Those two drugs (steroids and azathioprine) work really well together. Autoimmune [hepatitis] requires more of a lifelong treatment. At that stage, you can induce remission, but usually you don’t have withdraw treatment until about two years after it begins. You also have to monitor the labs very closely, because if the numbers spike, you have to resume that treatment.
Side Effects of Immunosuppressants
Your healthcare provider will likely recommend corticosteroids to reduce your immune activity and prevent your immune system from attacking your liver. In some cases, it may be prescribed in conjunction with another immunosuppressant Azasan (azathioprine).
Immunosuppressants can come with myriad side effects, especially if you have to take them for a longer than a few months. For patients with diabetes, the drugs can cause spikes in your blood sugar, so you will need to be constantly monitoring your insulin and communicating with your healthcare provider, in case you need to adjust your dose, explains Boone. Azathioprine may raise your risk for developing lymphoma, too.
Other side effects of corticosteroids and azathioprine include:
- Slower wound healing
- Weight gain
- Increased appetite
- Upset stomach
- High blood pressure
- Swelling, especially in your lower legs or face or both
- Mood changes
- Blurry vision
- Hair loss
If you take oral corticosteroids for a longer period, possible side effects include:
- Weakened bones (osteoporosis)
- High blood sugar
- Bruising easily and healing more slowly from wounds
- Higher risk of infections
If your liver has been damaged by alcohol, your first step is to stop drinking. If you are physically dependent, you may require supervised medical withdrawal. Then, your provider may recommend therapy and you may be prescribed a drug called acamprosate which can help combat alcohol cravings. You might also receive corticosteroids to dampen the inflammation.
The most common side effects of acamprosate are fear and nausea.
Questions to Ask Your Provider
If your healthcare provider recommends a treatment plan, based on your hepatitis diagnosis, below are questions you might ask:
1. How long might the treatment last?
2. What would happen without treatment?
3. Will any of my medicines or herbal supplements interfere with this treatment? (Let your provider know what those are.)
4. Are there any risks specific to my medical history?
5. How often do I need to see a healthcare provider while following this regiment?
6. What will the follow-up look like in one, five or 10 years?