Hepatitis

Hepatitis is a swelling of the liver.  It can be caused by viruses, opportunistic infections such as mycobacterium avium complex (MAC) or cytomegalovirus, antiretroviral drugs or poisons.

Viral hepatitis can be acute or chronic. Acute means that a person gets sick for a couple of weeks, but then recovers. Chronic hepatitis means that the liver might be inflamed for six months or more. Chronic hepatitis stays in the body. A person with chronic hepatitis can infect other people. His or her disease can become active again.

Without treatment, it can lead to scarring (cirrhosis) of the liver and liver failure, which can be fatal.

Because many anti-HIV drugs are processed by the liver, hepatitis can make treating HIV complicated.

Symptoms

There are seven known types of viral hepatitis. (They are hepatitis A, B, C, D, E, F and G viruses.) The most common are hepatitis A, B and C. Hepatitis B and C can lead to persistent or chronic infection. No matter what causes hepatitis, the signs are similar. They include:

• Dark, tea-colored urine and pale or clay-colored stools
• Loss of appetite
• Fatigue
• Abdominal pain or bloating
• General itching
• Yellowing of the skin or eyes
• Nausea and vomiting
• Low grade fever
• Weight loss

Many people with hepatitis don’t seek help quickly because they think they have the flu. Without treatment, hepatitis can keep damaging the liver. This may lead to scarring of the liver (cirrhosis), liver failure or liver cancer. A person with these types of hepatitis may have more side effects from the anti-HIV drugs he or she takes.

How serious hepatitis is depends on its cause, other illnesses that may also be present and the type of hepatitis. Hepatitis A, for example, is generally short-lived, not leading to chronic liver problems. 

Causes

Hepatitis can be caused by:

• Infections from parasites, bacteria or viruses (such as hepatitis A, B, or C). More than 90% of cases of hepatitis are caused by hepatitis A, B, or C. Other viruses such as cytomegalovirus, Epstein-Barr virus and yellow fever can also cause hepatitis
• Liver damage from alcohol, drug, or poisonous mushrooms
• An overdose of acetaminophen (Tylenol®), which is rare but deadly
• Immune cells in the body attacking the liver and causing autoimmune hepatitis
• Liver-damaging drugs such as methyldopa (an uncommon drug for high blood pressure), isoniazid for tuberculosis, seizure medications (like valproate and phenytoin), drugs used to regulate the heart beat such as chlorpromazine and amiodarone and certain antibiotics, including trimethoprim-sulfamethoxazole and erythromycin. People taking these drugs are usually given liver tests to monitor their health closely.

Risk Factors

The chances of getting hepatitis go up if a person:

• Uses injected drugs
• Takes too much Tylenol. The recommended dose and a dangerous dose are close. Be careful to take Tylenol only as directed. Many prescriptions mix Tylenol with other drugs. It is easy for a person to be taking more than he or she realizes.
• Has multiple sexual partners and unprotected sex
• Eats contaminated foods
• Travels to areas where hepatitis is common
• Lives in a nursing home
• Has a family member who recently had hepatitis A
• Abuses alcohol
• Has HIV or AIDS
• Had a blood transfusion before 1990, before the hepatitis C blood test was available
• Is born to a mother with hepatitis B or C. (The virus can be passed on during delivery.)
  Works in health care in contact with blood, including dentist and dental hygienist
• Has a tattoo

It also is important to keep the GI tract healthy while undergoing HIV treatment. A healthy GI tract helps the body absorb medications. 

Prevention

The best way to prevent viral hepatitis is through cleanliness. Hands should be washed after going to the bathroom and before handling food. When traveling eat only well-cooked food and drink bottled water.

A person should avoid close contact with people (or their blood) that have been infected with hepatitis. Condoms can help prevent the spread of hepatitis B. Razors, needles or toothbrushes should not be shared with a person who has hepatitis. People getting piercings or tattoos should be cautious.

There are vaccines that can protect you against developing hepatitis A and B, even if you've already been exposed to them. A shot of immunoglobulin may also prevent infection. This is true even after you have been exposed:

It may be given soon after you have had close contact (like kissing or sharing utensils) with someone who was diagnosed with hepatitis A within the last two weeks.

It should be given right away, along with the hepatitis B vaccine, to an infant born to a woman with hepatitis B.

A person who has had sexual contact or shared needles with someone who may have one of the hepatitis viruses should get tested. Testing is important even if the person has no symptoms. 

Diagnosis

The first step is to do a blood test to see how the liver is working.  This measures the amounts of certain chemicals.  If they are high, it may be a sign of hepatitis. Signs of viruses are also checked with the blood test. Sometimes it is necessary to take a sample of the liver (a biopsy) to look at under a microscope.

An ultrasound of the abdomen may be done to check for swelling in the liver. If the abdomen is swollen, fluid may be removed to check for infection. 

Treatment

About half of those with hepatitis C end up with chronic liver disease, liver failure (cirrhosis) or liver cancer. Other complications include an infection of the fluid in the belly and bleeding in the throat.

There are several drugs used to treat hepatitis:

• Interferon-alpha (used to treat hepatitis B and D)
• Two anti-HIV drugs, Epivir® (lamivudine, 3TC) and Emtriva® (emtricitabine, FTC). They are used to treat hepatitis B and D. Some newer drugs being tested to fight HIV also show promise in helping to fight hepatitis B.
• Adefovir dipivoxil (Hepsera®) was approved by the FDA in 2002 to treat hepatitis B
  The liver needs to be working properly to break down most drugs. Drugs that didn’t cause a problem when a person was healthy can make them very sick when they have hepatitis. 

Anything that can be done to reduce strain on the liver is helpful against hepatitis. Anything that irritates the liver, such as alcohol, aspirin, recreational drugs and some herbal products should be stopped. People with hepatitis should make sure that their doctors and pharmacists know all the drugs, supplements and herbal products they are taking.

Some anti-HIV drugs increase the risk of liver problems. It’s important to discuss all the drugs taken with a doctor and to be careful about not mixing drugs that can cause harmful impacts on the liver.

It can be helpful to:

• Eat most of the day’s calories early
• Rest

There are no effective treatments for hepatitis A and E, but they usually only last a couple of weeks.