Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.

How hepatitis A is spread?

The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another person’s mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on.

HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water.

Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk.

Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.

What are the signs and symptoms of hepatitis A?

It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:

• a short, mild, flu-like illness.
• nausea, vomiting and diarrhoea.
• loss of appetite.
• weight loss.
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
• itchy skin.
• abdominal pain.

The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital.

There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.

What does a positive test result mean?

HAV is tested for using a blood test. A positive test result means the patient has either had a past infection or is currently infected. The type of antibody detected in the test will indicate whether the infection is current or has been cleared. A patient who tests positive may be asked about recent contacts and sexual partners that may need to be tested too. A patient who has already had the infection and fought it off is naturally immune to HAV.

What does a negative test result mean?

A negative test result means the patient is not infected with Hepatitis A. If the patient is believed to be at high or ongoing risk of infection, our doctors may advise immunisation.

What is the treatment for hepatitis A?

There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. Our doctors will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.

Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.

Immunisation against hepatitis A?

Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.

The hepatitis A vaccine may be routinely recommended for young children living in areas with high incidence of hepatitis A, and anyone travelling to countries where hepatitis A is endemic. In addition, immunisation may be recommended for people whose sexual practices are likely to put them at risk.

Immunisation may also be recommended to prevent hepatitis A developing if a person suspects they have been exposed to the virus.

What is hepatitis B?

Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.

How does hepatitis B spread?

The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.

Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.

HBV can be spread in the following ways:

• by unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected.
• by sharing contaminated needles or other drug-injecting equipment.
• by using non-sterilised equipment for tattooing, acupuncture or body piercing.
• from an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B.
• through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.

Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.

What are the signs and symptoms of hepatitis B?

Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:

• a short, mild, flu-like illness.
• nausea, vomiting and diarrhoea.
• loss of appetite.
• weight loss.
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
• itchy skin.

If symptoms become severe then a person with hepatitis B may be admitted to hospital.

Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers.

If a person lives with hepatitis B infection for a number of years then they may develop the following complications:

• chronic hepatitis.
• liver cirrhosis.
• liver cancer.

What does a positive test result mean?

A positive test result could indicate either of the following:

• A past infection. This means the patient has already been in contact with hepatitis B and their immune system has succeeded in fighting off the virus. The patient will then have a natural immunity to the virus.
  
• The patient is a carrier. This means the patient is carrying HBV and can pass it on to others. The person may not display any symptoms but could be at risk of developing chronic liver disease.

Our doctors may perform a number of different types of test to distinguish between current and past infections, and to estimate how infectious a patient with a current infection may be.

What does a negative test result mean?

This result generally means the patient has never been infected with HBV and therefore has no natural immunity against the virus. If the person suspects they may have been recently exposed to HBV, our doctors may advise them to take a repeat test to confirm their negative status, and may also advise immunisation against hepatitis B.

What is the treatment for hepatitis B?

In most countries a patient with a positive test result will be referred to a specialist who will carry out further tests to determine the degree to which hepatitis B may be affecting the liver, and what may be the best treatment options. In these tests a small sample of liver tissue may need to be taken (a liver biopsy).

In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patient’s immune system should fight off the virus, giving the patient natural immunity.

In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV infection will become chronic. The virus is more deadly to the young and those that are infected at birth have a 25% chance of developing a life-threatening liver-related illness.

Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which the patient will be carefully monitored.

Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

Immunisation against hepatitis B?

Three immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check that they have worked. Immunity should last for at least 5 years.

What is hepatitis C?

Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent that hepatitis A or B. Worldwide, estimates suggest 170 million people are chronically infected with hepatitis C, with 3 to 4 million people newly infected each year.2

How hepatitis C is spread?

High-risk groups are the same in many societies and cultures. They include injecting drug users, people who receive transfusions of unscreened blood, haemophiliacs, dialysis patients and people who have unprotected sex with multiple sex partners.

The hepatitis C virus (HCV) can be spread in the following ways:

• by sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV and HIV outside sub-Saharan Africa.
• by using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
• through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
• rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
• through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
• by sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.

Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

What are the signs and symptoms of hepatitis C?

Many people do not experience any symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.

Symptoms may include:

• a short, mild, flu-like illness.
• nausea and vomiting.
• diarrhoea.
• loss of appetite.
• weight loss.
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
• itchy skin.

About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.

The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.

If a person lives with hepatitis C infection for a number of years then they may develop the following complications:

• chronic hepatitis.
• liver cirrhosis.
• liver cancer.

If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

What does a positive test result mean?

The first test searches for HCV antibodies in the patient’s blood. A positive result shows that the person has been exposed to the hepatitis C virus and their immune system has responded by producing antibodies.

This may mean that the patient is a carrier of the hepatitis C virus. Alternatively, the patient may have recently cleared an HCV infection and still have antibodies in their blood. Further tests will be conducted to discern whether the patient has a current infection.

A specialist will carry out a blood test that looks for the genetic material of the hepatitis C virus itself instead of the antibodies. This test will identify whether the virus is still present.

If the patient has successfully cleared the virus, this does not mean they are immune to reinfection.

What does a negative test result mean?

A negative result generally means the patient has never been infected with HCV. However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, our doctors may advise the patient to take a repeat test if they believe they may have been recently exposed to the virus.

What is the treatment for hepatitis C?

To determine the extent to which the liver has been affected by hepatitis C, two more tests will be carried out.

• The first is a liver function test (LFT) which measures substances (specific proteins and enzymes) in the patient’s blood, showing how effectively the liver is working.
• The second is a liver biopsy. A fine hollow needle is passed through the skin into the liver and a small sample is taken. The sample is then examined under a microscope to gauge the amount of liver damage (inflammation, scarring and cirrhosis).

Treatment for hepatitis C has improved in recent years, but at maximum efficacy it is still only successful at clearing HCV in around 30%-50% of patients.

Treatment combines the antiviral drugs interferon and ribavirin. Interferon can be used alone but is then less effective (around 10%-20%). The antiviral drugs may cause significant side effects that may be intolerable for some people. These include:

• headaches.
• flu-like symptoms.
• nausea.
• tiredness.
• body aches.
• depression.
• skin rashes.

The cost of this antiviral treatment is high, making it difficult to access in low-income and developing countries. A patient will also require regular check-ups to monitor their progress.

It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

How can we prevent hepatitis C?

Currently, there is no vaccine to hepatitis C, but research is in progress. Like HIV, HCV can mutate easily, which makes vaccine development complicated. As no vaccine exists, all measures should be taken to prevent HCV transmission.

Injecting drug users should never share any needles, syringes or mixing spoons, as blood can be transferred between users.

Infection through penetrative sex does occur, although it is not common. If a person is infected with HCV, it is advisable for them to use a condom for penetrative sex to ensure that they do not pass on the virus to their partners through any open genital cuts or sores.

People should avoid sharing toothbrushes, shaving equipment (especially razors), or anything else that may be contaminated with infected blood.

Our doctors will advise the patient of any precautions necessary to avoid infecting others with the virus.