Hepatitis, an overview

By Cristiano Antonino On Apr 28, 2023

According to the World Health Organisation (WHO), more than 350 million people worldwide live with chronic hepatitis type B or C

But these forms of hepatitis are not the only ones possible: other viruses or other causes may also be at the root of liver inflammation.

Here is what you need to know about this disease.

Hepatitis, what it is

Hepatitis is an inflammation of the liver in which there is more or less extensive destruction of the cells of this organ.

The most frequent forms are viral, due to viruses that manage to penetrate the body and reach the liver.

However, there are also other forms of hepatitis, such as autoimmune hepatitis, which appears when the body produces antibodies against liver tissue, and those occurring as a secondary consequence of drugs, toxins and alcohol.

Viral forms of hepatitis

Viral hepatitis can be triggered by five main types of viruses: A, B, C, D and E.

Liver cells die from the direct action of the virus or from the action of the immune system against it.

Typically, at onset, these hepatitises give rise to an acute form, which corresponds to the initial state of the disease.

Some of them may evolve into a chronic form: this happens when the immune system has been unable to remove the infection at the time of infection.

There are also two ‘minor hepatitis viruses’ that can also cause acute hepatitis: Cmv and Ebv.

Hepatitis A

As its name implies, hepatitis A is caused by the hepatitis A virus, also called Hav.

The disease is present worldwide: in some areas it is epidemic (especially in poor countries with poor hygiene conditions), i.e. it affects a large number of people, while in others it occurs sporadically.

The Hav virus is mainly transmitted by the faeco-oral route, through the consumption of contaminated raw or undercooked water and food.

Often the disease is asymptomatic or manifests itself so mildly that the person does not notice anything.

When it does manifest, it does so with symptoms such as tiredness, malaise, lack of appetite, fever, nausea, abdominal pain and jaundice.

Unlike other forms, such as C and B, hepatitis A only manifests itself in an acute form and never becomes chronic: those affected always recover.

There is no real cure: the best thing is to wait for the disease to run its course.

However, it helps to rest as much as possible, so as not to aggravate malaise and fatigue, to drink a lot and to follow a healthy diet, low in heavy, fatty foods and alcohol, so as not to further burden the liver.

It is important to know that there is a vaccine that protects against hepatitis A, which is useful for people travelling around the world, for example.

Hepatitis B

It is caused by the HBV virus.

There are three main routes of transmission: contact with infected blood, sexual contact and transmission from infected mother to newborn child.

In adults with an efficient defence system, acute B infection heals spontaneously in the vast majority of cases.

In infants and children, on the other hand, the infection becomes chronic in more than 50% of cases.

Often the infection shows no signs of its presence or causes flu-like complaints, such as tiredness, joint pain, liver pain.

In a small number (30%) of people, the infection causes symptoms such as jaundice (skin and mucous membranes turn yellowish), profound tiredness, intestinal disorders (such as nausea), dark urine.

The acute form almost never requires treatment, unless complications arise.

People with chronic active infections, on the other hand, often need to be treated, with drugs such as interferon, nucleoside or nucleotide analogues.

Hepatitis C

Hepatitis C is caused by the HCV virus (Hepatitis C Virus), which penetrates the body mainly through the bloodstream and reaches the liver, where it reproduces.

In the initial stages of acute infection, hardly any symptoms appear.

Only a small percentage of patients present with symptoms characterised by nausea, fever, mild fatigue, muscle pain and jaundice.

In 70-80% of cases, the virus persists for more than six months and a chronic form develops.

This form can also remain asymptomatic, often for decades, or cause non-specific complaints such as fatigue, muscle pain, memory impairment.

The acute form is likely to heal spontaneously, whereas the chronic form requires specific treatment, based on drugs such as pegylated interferon, ribavirin, peginterferon alpha-2°, the new antiviral drugs.

Hepatitis D

This is a rare form that only occurs in conjunction with hepatitis B infection.

Hepatitis D virus (HDV) causes inflammation of the liver like other strains, but a person cannot contract HDV without an existing hepatitis B infection.

Two situations can occur: co-infection, in which a patient is simultaneously infected with both viruses, and over-infection, in which the delta virus infects a person who was already a chronic B virus carrier.

Globally, HDV affects almost 5% of people with the chronic B form.

The majority of Delta infections take the form of acute hepatitis of varying severity.

The infection tends to become chronic in 90% of cases.

In acute hepatitis, the symptoms are the same as those of the other forms of acute hepatitis, A, B and C, whereas if it is a flare-up of chronic disease, the symptoms are more nuanced.

There is no effective treatment for the delta virus.

Only interferon has proved useful in a limited number of cases.

Often, the only possible treatment is transplantation.

Hepatitis E

This is an inflammation of the liver caused by the type E virus (HEV), of which at least four genotypes are known.

It is especially widespread in areas with poor hygiene conditions and is transmitted through contact with contaminated water.

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In industrialised countries, the disease is often transmitted by animals, such as pigs, wild boars and chickens.

Shellfish can also transmit the virus.

It is mainly manifested by jaundice (yellowish discolouration of the skin and eyes), fever, loss of appetite, abdominal pain, lethargy and neurological manifestations.

In most cases, the disease resolves spontaneously with rest, light feeding and strong hydration.

Toxic hepatitis

As its name implies, toxic hepatitis is caused by substances that are toxic to the liver, such as certain medicines (the metabolisation and elimination of most drugs takes place in the liver) or preparations of natural origin used for prolonged periods or in large doses, alcohol consumed in excessive quantities especially when combined with drug use, mushrooms.

Toxic hepatitis may be asymptomatic or manifest with symptoms such as jaundice, weakness, malaise.

In both cases, it can cause an elevation of transaminases and other blood parameters (such as gamma-GT).

To treat it, intake of the toxic element must be stopped.

In cases of mushroom poisoning, gastric lavage may be useful, but only if done very early on.

In some cases, specific therapies can be used, such as high-dose acetylcysteine in mushroom or paracetamol poisoning.

To help the liver recover, it is useful to observe a few weeks’ rest, eat a light diet, and avoid overwork.

In cases of severe toxicity, liver transplantation is sometimes necessary.

The autoimmune form

In this case, the inflammation of the liver is caused by an abnormality of the immune system, which mistakenly considers liver cells and tissue to be foreign to the body and attacks them.

This causes chronic and progressive inflammation that destroys tissue and leads to liver failure and portal hypertension.

It is most common in people between the ages of 40 and 70, in those who have had previous viral or bacterial infections, in those who use certain medications, and in those who suffer from other autoimmune diseases

In most cases the disease is asymptomatic.

Only sometimes nuanced and non-specific symptoms may appear, such as tiredness or a feeling of a bitter mouth or jaundice, i.e. yellow discolouration of the skin.

The autoimmune form requires the use of immunosuppressive drugs combined with cortisone.

Alcoholic hepatitis

This is a form that depends on alcohol abuse, which inflames the liver and damages it.

If no action is taken, fibrosis (scar formation) typical of cirrhosis of the liver ensues, with permanent liver damage.

It manifests itself with symptoms such as fever, asthenia, jaundice, pain in the right upper abdominal quadrant, as well as an increase in the volume of the liver itself detectable by touch and accompanied by some pain.

Treatment is based on the elimination of alcohol. Corticosteroids may also be necessary.

In severe cases, a liver transplant is needed.

The fulminant form

This disease can be an evolution of viral hepatitis or hepatitis caused by acute abuse of alcohol, toxic substances, drugs, medicines, especially in the case of abuse (this is the case with common paracetamol, which is harmful in particularly high dosages).

It leads to massive necrosis of the liver cells and requires a liver transplant.

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