Though most of us are familiar with the term ‘hepatitis’ in regards to the disease’s viral forms – A, B, and C – hepatitis is actually a condition that can be triggered by a plethora of causes. These can include excessive alcohol consumption, hereditary liver diseases, hemochromatosis, and even medications that are toxic to the liver, among other things. Hepatitis is basically a fancy term for an inflamed liver (formed from a combination of the words ‘hepa,’ meaning liver, and ‘itis,’ meaning inflammation), and the concern in this inflammation stems from its potential to cause scarring and permanent damage.
Dr. Bzowej began her explanation of the causes of hepatitis with the most common viral types. Hepatitis A is a disease that is transmitted fecal-orally, so it can be contracted from contaminated food and water. This marks a large difference between type A and types B and C. “The other big difference is that A doesn’t lead to a chronic disease,” Bzowej explained, “Hepatitis A causes an acute illness, something short-lived, and you can get very sick from it.” If the viral infection is serious enough, it can cause life-threatening damage that may necessitate a liver transplant. On the other hand, many patients who contract type A mistake it for the flu due to the similar symptoms – nausea, vomiting, diarrhea, jaundice, and fever – and never realize they were infected in the first place. “It’s a spectrum in terms of how much illness it will cause,” Bzowej added. Once you clear the virus, you’re immune to it for the rest of your life. A vaccination for type A exists, as well, and is recommended for persons traveling to a country endemic with hepatitis.
Hepatitis B differs from A in that it is contracted blood-to-blood, and if you’re exposed to it as an adult, you have a 5 to 10% chance of going on to a chronic illness. Unfortunately, children exposed to type B are a different story and have a 90 to 95% chance of continuing on to a chronic form. Rates of chronic hepatitis B are large in immigrant populations from various countries that do not have the resources to vaccinate babies at birth, so many children born in countries endemic with hepatitis B contract it for that reason. About New Orleans, Bzowej mentioned, “We have pockets in the US that have a high prevalence of hep B, and New Orleans is one of those areas. We have a very large Vietnamese population, and there’s more hepatitis B in the African American population, so it’s an issue here.” The main problem with type B is that is it a silent disease – until tested, many are unaware that they’ve contracted it until they begin to experience problems. Unlike the other forms of hepatitis, patients do not need to have a lot of liver scar tissue before they develop liver cancer. The disease cannot be cured, but it can be controlled very well with interferon and antiviral oral agents, reducing the need for liver transplants due to liver failure. “The main reason we transplant hepatitis B now is due to cancer.”
Though also transmitted via bodily fluids, 85% of adult patients who contract hepatitis C do go on to a chronic disease, unlike type B. However, like B, the disease is hard to diagnose and recognize, as patients don’t get terribly sick. Bzowej said, “They might have [flu symptoms], but they probably don’t even go see their doctors.” Recently, the CDC recommended that baby boomers born between 1945 and 1965 be screened, as 75% of Americans that have hepatitis C aren’t aware that they’re infected. “Patients that acquired it in the 60s and 70s are now coming to us with cirrhosis [a completely scarred liver], liver cancer, or liver failure, and it’s the number one indication for liver transplants in the United States.” Luckily, there are now available treatments for C, and there are many new ones on the horizon. Interferon, which boosts one’s immune system, can be used to help a patient fight the virus. Bzowej added, “We, in 2011, approved the first two medications – protease inhibitors – that work directly on the virus. That’s quite exciting. They’re very similar to the medications that revolutionized the treatment of HIV.”
Bzowej next addressed the non-viral causes of hepatitis, starting with Tylenol. “Chronic Tylenol use doesn’t cause chronic hepatitis, but if somebody took large quantities of Tylenol, [they] could get an acid insult to the liver and require a liver transplant.” Not all pain killers come with this risk, but it is important to follow the directions on a medication’s label for this reason. “We also see patients who don’t realize that they need to really follow the package insert…and they take large quantities [of Tylenol] because they’re in so much pain.” Other medications have potentials for side effects to the liver, including cholesterol-lowering and anti-fungal medications. Before a patient begins taking a medication that may be toxic to the liver, the risk-benefit is evaluated, and if it is determined that the benefits are worth the risks, the liver and its enzymes are monitored through blood tests.
Excessive alcohol consumption can also lead to hepatitis through fatty liver disease in persons who surpass the recommended daily limit of one drink per day. Moreover, if you’re already at risk for liver disease, alcohol can aggravate that risk. Morbid obesity also causes fatty liver disease, but the presence of fat in the liver is not exclusive to obese or overweight individuals. “It’s a process that’s not well-understood,” Bzowej clarified, “There’s a lot of research going on to try and understand why some people just have fat that sits in the liver…In some people, the fat sits there for a time, and they’ll be okay. But then some switch turns on and the liver starts reacting to the fat and becomes inflamed, leading to scarring.” Persons at risk for fatty liver disease are those with diabetes, high cholesterol, or a family history of the condition.
Even though the liver is capable of astounding regeneration – a whole liver can regrow from as little as 25% of the original organ – its purpose is vital to the human body, and extreme scarring can permanently disable the organ from functioning as normal. To keep your liver running as it should, take medication only as prescribed or detailed by the package insert, limit excessive alcohol consumption, and add a simple blood test for viral hepatitis to your check-up if you’re part of an at-risk population. If you want to help raise awareness about the disease, you can participate in Avita Drug Pharmacy's local World Hepatitis Day event on July 28th (details here).