Hepatitis is a silent illness with often ambiguous symptoms. Some people are unaware that they have this liver infection until they are already seriously ill. It's an illness that can strike anyone regardless of age, occupation, ethnic background or lifestyle.
Hepatitis is much more common than most people believe. For example, in Germany, about 1 million people are estimated to have this illness in a population of 82 million. This is according to Heiner Wedemeyer, a member of the German Liver Foundation and a physician at Hanover Medical School's Department of Gastroenterology, Hepatology and Endrocrinology. "Fewer than half of them know that they're infected, though," he said.
The diagnosis is often made incidentally, said Ingo van Thiel of the German Liver Help Association, a nationwide charitable organisation that describes itself as an "information interface" between doctors and liver patients.
There are several hepatitis viruses. A bout of acute hepatitis A or B prompts sufferers to see a doctor, said Dietrich Hueppe, chairman of the Association of German Gastroenterologists in Private Practice. Common symptoms are indisposition, fatigue, yellowing of the skin and eyes (jaundice), and nausea. Chronic hepatitis B or C, on the other hand, progress slowly and go unnoticed for a long time, Wedemeyer said.
All types of hepatitis cause liver inflammation. If a case of hepatitis is detected late or has become chronic, the liver scars. This condition, called cirrhosis, restricts the liver's ability to function properly, Hueppe explained. Cancer of the liver cells can develop in the scar tissue "so the goal of hepatitis treatment is to prevent cirrhosis and cancer of the liver," he said.
Hepatitis A is often contracted by travellers in developing countries. According to van Thiel, it is both the most contagious and the most harmless type of hepatitis. The virus is found in faecal matter and usually transmitted by contaminated water or food. "Hepatitis A always heals on its own," he said. "The elderly and people with liver disease don't get over it so easily, however." An infection can be prevented with the hepatitis A vaccine and good hygiene.
Hepatitis B is much more dangerous than hepatitis A and "highly contagious via blood," van Theil said. Wedemeyer characterised this type of hepatitis as a venereal disease because it is transmitted mainly through blood, semen or other body fluids during sex. The use of condoms, particularly by people with multiple sex partners, and the hepatitis B vaccine - usually taken in combination with the hepatitis A vaccine -offer protection.
According to the German Liver Help Association, about 90%of healthy adults recover fully from hepatitis B. Wedemeyer noted that medications are available that suppress replication of the virus in the liver so that the infection does not advance further. "By so doing, we prevent the clinical endpoints," he said, meaning the onset of cirrhosis and cancer.
Virus most likely to stay in body
"An insidious property of hepatitis B is that recovery from the infection doesn't mean the virus has left the body," van Thiel said. Another outbreak is possible decades later if the person's immune system is severely weakened, for example as a result of chemotherapy for cancer, a bone marrow transplant or AIDS. "You should therefore never forget you've had it and always inform your doctor," he said.
Like hepatitis B, hepatitis C is among the infectious diseases on the World Health Organisation's list of those that must be urgently fought worldwide. Of all the types of hepatitis, it is the one that most frequently becomes chronic. But hepatitis C is transmitted less often during sexual intercourse than type B, Hueppe said. "Based on what we know today, this virus type is transmitted almost exclusively via blood," van Thiel said.
Wedemeyer therefore advises anyone who received a blood transfusions before 1992 - when improved blood-screening tests became available - to be tested for hepatitis C. Sharing needles during illegal drug use is another source of infection.
Depending on the hepatitis C virus subtype, the infection can be cured with medications between 40-90% of the time, Wedemeyer said, adding that he expected considerably better cure rates in two or three years when an interferon-free virus inhibitor comes on the market. There will no vaccine in the foreseeable future, he said.
(Sapa, July 2012)