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Hepatitis

MEDICATIONS

Disease Outcome of Hepatitis

Disease Outcome of HAV

Hepatitis A will clear up on its own in a few weeks or months with no serious after effects. Once recovered, an individual is then immune for life to HAV through the presence of the IgG antibody. About 1 in 100 HAV sufferers may experience a sudden and severe (i.e., "fulminant") infection.

Disease Outcome of HBV

Either you develop immunity to HBV . . . 95% of adults infected develop antibodies and recover spontaneously within six months. Upon recovery, they develop immunity to the virus and they are not infectious to others. Blood tests will always test positive for the HBV antibody. Blood banks will not accept donations of blood from HBV-immune people.

OR you become chronically infected. About 5% of the time, the virus clears the body within six months. If so, a person is considered a carrier - or chronically infected. Chronically infected people may or may not show outward signs or symptoms. The HBV virus remains in blood and body fluids, and can infect others.

Disease Outcome of HCV

Between 20- 30 percent of HCV sufferers are able to become virus-free with proper treatment. Between 70 80% of the HVC infections reported each year become classified as chronic. Chronic HCV refers to infections that do not clear up within 6 months after the acute infection. Within the chronically infected group, about 20% go on to develop cirrhosis (scarring of the liver). Of this group, 25% may develop liver failure, even though this may take 30-40 years. Cirrhosis slows the blood flow through the liver and causes increased pressure in the vein that carries blood from the stomach and the intestines to the liver. As a result, varicose veins (e.g., "varices") may develop in the stomach and esophagus. Without warning these large veins can break causing a person to vomit blood or have black, tarry stools. An estimated 8,000-10,000 deaths occur each year resulting from the complications of HCV.

Treatment for Hepatitis

Treatment for HAV

No specific treatment is necessary for hepatitis A. Disease.

Treatment for HBV

There are two medications to treat chronic HBV - Interferon (IFN) and Lamivudine. Less than 50% of patients with chronic HBV are candidates for interferon therapy. Initially, 40% of HBV patients who are treated with IFN will respond. However, some will relapse when the treatment is stopped. Overall, about 35% of the eligible patients will benefit. IFN treatments may have a number of side effects, including flu-like symptoms, headache, nausea, vomiting, loss of appetite, depression, diarrhea, fatigue, and thinning hair. Interferon may lower the production of white blood cells and platelets by depressing the bone marrow. Thus, blood tests are needed to monitor blood cells, platelets, and liver enzymes. The response to oral Lamivudine, given for at least one year, may be somewhat lower. In addition, those who are chronically infected with HBV should be vaccinated against hepatitis A. There is no treatment for acute Hepatitis B.

Treatment for HCV

There are three types of interferon, plus a combination of interferon and ribavirin, used to treat hepatitis C. Blood tests and liver biopsy findings may determine the need for treatment.

Interferon must be given by injection, and may have a number of side effects, including flu-like symptoms - headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.

Ribavirin, given by mouth, can have additional side effects including depression, severe anemia and especially birth defects. Women or the male partners of women, who are pregnant or who are planning pregnancy, should not take ribavirin. Pregnancy should not be attempted until six months after treatment is ended. Ribavirin may also interfere with the production of red blood cells and platelets by depressing bone marrow. Patients should be monitored frequently.

While 50-60% of patients respond to treatment initially, sustained response occurs in up to 40%.
Treatment of children with HCV is under investigation.
Researchers are re-examining when treatment should begin, for how long it should continue, and its effectiveness.
Many pharmaceutical companies and NIH are conducting research to find more effective treatments and cures.
Currently, almost 1/2 of all liver transplants in the US are performed for end-stage hepatitis C. However, re-infection of the transplanted liver by the virus usually occurs and may require a second transplant.
Try to maintain as normal a life as possible, eating a well-balanced diet, exercising and keeping a positive attitude. Avoid depressing or overwhelming tasks and learn.

PROCEDURES

Treatment & Therapy
Who should have Hepatitis Vaccine?

Who should have the HAV vaccine?

Users of illegal drugs.
Individuals who have chronic liver disease or blood clotting disorders (e.g., hemophilia).
Those who have close physical contact with people who live in areas with poor sanitary conditions.
Those who travel or work in developing countries. This includes all countries except northern and western Europe, Japan, Australia, New Zealand, and North America except Mexico.
Men who have sex with other men.
Children in populations that have repeated epidemics of hepatitis A (e.g., Alaska natives, American Indians, and certain closed religious communities).
People who have chronic liver disease.

Get an HBV vaccination

Here's who should be vaccinated without fail:
All individuals living in the same household with a chronically infected individual.

All newborns and children up to the age of 19.

Those who are in positions where they are exposed to blood at work, through drug use, or who have multiple sex partners.

Individuals with hepatitis C and other chronic liver diseases.
Vaccination provides protection for more than 15 years, and possibly a lifetime. HBV booster shots are not recommended.

Newborn Vaccination

All newborns should get three vaccination doses of the HBV vaccine the first within 12 hours of birth, the second at 1-2 months, and the third at 6 months. In addition, babies born to infected mothers should receive a shot called H-BIG within 12 hours of delivery. Without the above intervention, 90% of babies born to infected mothers will become chronically infected, reducing their life expectancies. A few months after the last dose is given, the doctor will test to see if the baby is making HBV antibodies. If so, the baby will be safe from hepatitis B for life. HBV-infected mothers may nurse their babies.

Preventing Hepatitis

Preventing Hepatitis A Virus Infection

HAV infection is preventable! Here's how you do it:

Get an immune globulin (IG) shot. An IG shot can provide temporary immunity to the virus for 2 to 3 months when given prior to exposure to HAV or within 2 weeks after exposure.
Ask for the HAV vaccine. The HAV vaccine, made from inactive hepatitis A virus (synthetic), is highly effective in preventing the hepatitis A infection. However, its safety when given during pregnancy has not been determined. Check with your doctor to determine how many shots you need. The vaccine provides protection for about four weeks after the first injection; a second injection protects you longer, possibly up to 20 years.

Preventing Hepatitis B Virus Infection

Things you can do:
Practice safe sex (use latex condoms).

Don't share anything that could have an infected person's blood on it, i.e. toothbrushes, razors, nail clippers, body piercing instruments.

Don't share drug needles, cocaine straws or any drug paraphernalia.

Cover all sores and rashes and do not touch them.

Clean up any blood spills with a 10% solution of household bleach. Infected persons should not pre-chew food for babies.

If exposed to hepatitis B, get an HBIG (hepatitis B immune globulin) injection within 14 days following exposure.

Preventing Hepatitis C Virus Infection

There is NO vaccine to prevent HCV.Vaccines for Hepatitis A and B do not provide immunity against hepatitis C. There are various genotypes of HCV and the virus undergoes mutations making it difficult to develop a vaccine.

Avoid handling anything that may have the blood of an infected person on it, such as razors, scissors, toothbrushes, nail clippers or files, tampons or sanitary napkins, etc. Detergent and a 10% solution of household bleach is believed to kill the virus.

Don' t share drug needles, cocaine straws or any drug paraphernalia.

Practice safe sex (use latex condoms).

Notify your physician and dentist that you have hepatitis.

Get vaccinated against hepatitis A and B.

Those infected with hepatitis C should not drink alcohol, as it accelerates the liver damage.

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