Hepatitis

While some types of hepatitis bring on a flulike illness and disappear, others cause chronic silver disease that can prompt life-threatening complications. New therapies are proving effective for such stubborn infections, even offering a cure for some.

What is happening

Hepatitis means 'inflammation' of the liver' and is usually caused by an infection from one of the hepatitis viruses. These organisms zero in on your liver and multiply, inflaming it and causing potential damage. Other infections, medications, exposure to toxic chemicals, immune system disturbances or years of alcohol abuse may also be responsible. A truly vital organ for cleansing your body of wastes and promoting digestion, your liver secretes a yellow fat-digesting substance called bile. If the liver becomes inflammed by hepatitis, bile backs up, giving your skin and eyes a yellowish tinge called jaundice. You may feel tired, feverish, nauseated, achy or itchy, with a nagging abdominal pain on your right side, where your liver is located.
  Your disease may be short-lived (acute) or persistent (chronic). Acute hepatitis is usually caused by the type A hepatitis virus. It spreads through tainted food or water and can make you quite sick for several weeks, but is usually goes away without causing complications. Hepatitis B is found in body fluids including blood, semen and breast milk. It can easily be transmitted  through sexual activity, sharing needles and from mother to child. Some people who contract hepatitis B will become chronically infected. Hepatitis C causes a noticeable illness in only 5 percent of people at the time of infection. It is transmitted by blood to blood contact. About 75 percent of people with hepatitis C will have a chronic infection.

LIKELY FIRST STEPS

• If you have acute hepatitis (type A), ask your doctor if family member or close contacts should receive a gamma globulin injection.
• Antiviral drugs may be prescribed for chronic forms of the disease including interferon (for hepatitis B), which can also be combined with ribavirin (for hepatitis C).
• You may need a liver biopsy (a thin needle that is inserted to remove some tissue) to assess damage to that organ.
• Regular follow-up visits and blood tests to assess liver enzymes and the amount of virus in your body.

QUESTIONS TO ASK

• What type of hepatitis do I have--A, B, C or another?
• If I've never had a transfusion, how did I get hepatitis?
• Am I contagious? Can I give this to my partner or kids? If I get pregnant, how can I protect the baby?
• Do you think my condition will get worse?
• How often will I need follow-up visits?
• What could happen if I decide not to use any treatments?
• Will I eventually need a liver transplant? 

  If you have chronic hepatitis, you are not alone. More than 150,000 Australians have chronic hepatitis B and more than 20,000 have hepatitis C, with millions more sufferers worldwide. In New Zealand, there are 30,000 carriers of the various hepatitis viruses. Most people were infected years ago, before blood was carefully screened; You may have carried B or C around for decades without even knowing you were infected. And many chronic viral carriers never develop liver problems. Treatment is the key to help prevent lasting damage, including severe and potentially fatal liver scarring (cirrhosis) or cancer.

Treatments

Therapies are limited for acute type A hepatitis (see on shortly). More and more people, however, are learning they have chronic hepatitis, especially type C, and effective virus-fighting drugs are available for this. Doctors generally recommend medications only if tests such as a liver biopsy show you have an active disease that isdamaging your liver. New drug combinations appear to be increasingly effective at keeping such conditions as cirrhosis and liver cancer, as well as other long-range complications, at bay.

                                                                           Treatment Options 
MEDICATIONS
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Antivirals                                                 Interferon, ribavirin; ask about pegylated intereron injections.
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Nucleoside analogue                             Lamivudine to control hepatitis. B.
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Immunosupressants                              Indefinitely after liver transplant.

PROCEDURES
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 Liver transplant                                      Viable option for advanced hepatitis C.

NATURAL METHODS
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 Herbs                                                        Certain botanicals can strengthen the liver.

TAKING CONTROL

• Refrain from alcohol, which can tax your liver. If you have acute illness, hold off for at least a month after recovery to give your liver a rest. If you have chronic disease, avoid alcohol long term.
• Don't smoke. Researchers in Taiwan report that cigarettes can further damage your liver, especially if you drink.
• Watch your drugs and medications. All are processed through the liver and can tax that organ if you're recovering from hepatitis. Even common pain relievers such as aspirin and paracetamol (Panadol, Panamax) can be potentially harmful. Check with your doctor about the drugs you're taking.
• Get plenty of rest. Set limits and adjust your schedule so that you don't overdo it.
• Relax. Stress-relieving techniques such as meditation, massage or even a hot bath can help you to unwind.

PROMISING DEVELOPMENTS

• Drug 'cocktails' now being developed may boost the effectiveness of  existing drugs and enhance the likelihood of cure. One, called a protease inhibitor, blocks a protein that hepatitis C viruses require to reproduce, stopping the virus dead in its tracks. Even more promising are polymerase inhibitors, such as adefovir dipivoxil, which prevent hepatitis B viruses from making copies of themselves. A third prospect, ribozyme, is an enzyme that acts like a microscopic pair of shears to snip the hepatitis B or C virus into inert pieces.  

  Because the usual virus-fighting therapies can have some unpleasant side effects, you may wonder if starting medicines is the right choice, particularly since you may have felt perfectly fine when you received your diagnosis. Truth be told, a number of patients refuse or drop out of therapy because of the troubling side effects. Whether this is a wise decision is not yet fully known. On a positive note, the newer drug combinations are less likely to cause unpleasant side effects, so if your doctor has suggested you start therapy (especially if your liver biopsy shows inflammation), you're better off going along with the drug program than abandoning it. Lifestyle choices can also contribute to--though not guarantee--a good outcome for your liver. A healthy diet, stress reduction, avoiding liver toxins such as alcohol and plenty of rest all seem to be valuable for maintaining a healthy liver.