What Are HIV & AIDS? Symptoms, Treatment, and Prevention

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Medicinenet.com

The first human case of a strain of hepatitis E previously found only in rats was diagnosed in a Hong Kong man who received a liver transplant in May 2017.

University of Hong Kong researchers said the 56-year-old man was cured of the liver disease in March, The New York Times reported.

The case is “a wake-up call,” according to Dr. Yuen Kwok-yung, chairman of the infectious diseases section of the microbiology department at the university.

The researchers said the man’s infection was not related to his liver transplant, but rather to factors such as rat droppings and open piles of garbage near his home, The Times reported.

Routine hepatitis E testing would not have detected the man’s infection, because the rat strain is much different than the one that typically infects humans, the researchers explained.

They said the rat strain of hepatitis E was discovered in 2010 in Germany and has been found in rats across the world, including the United States.

Most human cases of hepatitis E typically cause mild symptoms such as nausea and diarrhea, but such infections can be more serious for patients with weakened immune systems, The Times reported.

The human strain of hepatitis E infects 20 million people each year and about 44,000 people died from it in 2015, according to the World Health Organization.

 

Hepatitis: Surprising Things That Can Damage Your Liver

Sugar

Too much sugar isn’t just bad for your teeth. It can harm your liver, too. The organ uses one type of sugar, called fructose, to make fat. Too much refined sugar and high-fructose corn syrup causes a fatty buildup that can lead to liver disease. Some studies show that sugar can be as damaging to the liver as alcohol, even if you’re not overweight. It’s one more reason to limit foods with added sugars, such as soda, pastries, and candy.

Herbal Supplements

Even if the label says “natural,” it may not be OK for you. For instance, some people take an herb called kava kava for menopause symptoms or to help them relax. But studies show that it can keep the liver from working right. That can lead to hepatitis and liver failure. Some countries have banned or restricted the herb, but it’s still available in the U.S. You should always talk to your doctor before you take any herbs to make sure they’re safe.

Extra Pounds

The extra fat can build up in your liver cells and lead to non-alcoholic fatty liver disease (NAFLD). As a result, your liver may swell. Over time, it can harden and scar liver tissue (doctors call this cirrhosis). You are more likely to get NAFLD if you are overweight or obese, middle-aged, or have diabetes. You may be able to turn things around. Diet and exercise can stop the disease.

Too Much Vitamin A From Supplements

Your body needs vitamin A, and it’s fine to get it from plants such as fresh fruits and vegetables, especially those that are red, orange, and yellow. But if you take supplements that have high doses of vitamin A, that can be a problem for your liver. Check with your doctor before you take any extra vitamin A because you probably don’t need it.

Soft Drinks

Research shows that people who drink a lot of soft drinks are more likely to have non-alcoholic fatty liver disease (NAFLD). Studies don’t prove that the drinks were the cause. But if you down a lot of sodas and have been meaning to cut back, this could be a good reason to switch what you sip.

Acetaminophen

You’ve got a sore back, or a headache, or a cold, and you reach for a pain reliever. Be sure to take the right amount! If you accidentally take too much of anything that has acetaminophen — for instance, a pill for your headache and something else for your cold, and both have acetaminophen in it — it can harm your liver. Check the dose and how much is OK to take in one day. Stick to those limits, and you should be fine.

Trans Fats

Trans fats are a man-made fat in some packaged foods and baked goods. (You’ll see them listed as “partially hydrogenated” ingredients). A diet high in trans fats makes you more likely to gain weight. That’s not good for your liver. Check the ingredients list. Even if it says “0” grams of trans fat, it may still have a small amount, and that adds up.

Mistakes Happen

A doctor or nurse gets nicked by a needle they’ve used on a patient. Or people injecting illegal drugs share a needle. The needle isn’t the problem. It’s what’s on it. Hepatitis C can spread through blood. Even if it only happened once, or you’re at high risk for other reasons (like if you have HIV or your mom had hepatitis C while pregnant with you), you should get tested. So should everyone born from 1945 through 1965.

Less Alcohol Than You May Think

You probably already know that drinking too much is bad for your liver. But you might not realize that “too much” can happen without you being an alcoholic or addicted to alcohol. It’s easy to drink more than you think. Many glasses can hold a lot more than one standard serving, which is 5 ounces of wine (that’s a little more than half a cup), 12 ounces of regular beer, or 1.5 ounces of liquor. If you drink, be sure to keep it moderate — that’s one drink a day for women and up to 2 per day for men.

Reviewed by Jennifer Robinson, MD

Hepatitis: How Do You Get Hepatitis A, B, and C?

What Is Hepatitis?

Hepatitis means inflammation of the liver. It can be caused by several viruses. The main types in the United States are A, B, and C. Type A symptoms are often similar to a stomach virus. But most cases resolve within a month. Hepatitis B and C can cause sudden illness. However, they can lead to liver cancer or a chronic infection that can lead to serious liver damage called cirrhosis.

Hepatitis A Transmission

It is easier to contract hepatitis A than hepatitis B and hepatitis C. It is possible to contract hepatitis A by being in close contact with an infected person. The virus is spread via the fecal-oral route of transmission. This involves eating food or consuming a beverage that contains fecal matter of an infected person. This can happen when people do not thoroughly wash their hands after using the restroom and prepare food or drinks. It is possible to contract hepatitis A through sexual contact. Hepatitis B and hepatitis C are spread by having contact with semen, blood, or other body fluids of an infected person.

Water and Produce

It is possible to contract hepatitis A by eating uncooked, contaminated fruits and vegetables. Drinking water in developing countries may also be contaminated with the virus. Get in the habit of washing fresh fruit and vegetables thoroughly before eating them. If you are visiting a developing country, do not drink the tap water. Drink bottled water instead. Avoid ice as well. It is possible to be vaccinated against hepatitis A and hepatitis B. There is no vaccine available for hepatitis C.

Undercooked and Raw Shellfish

Shellfish are animals that filter the water from their surroundings. Because of this, they can become contaminated with hepatitis A virus if they are grown in polluted waters. To be safe, cook shellfish thoroughly before eating it. Undercooked shellfish like oysters, mussels, and clams may harbor and transmit hepatitis A. You may prefer the taste of raw oysters, but cooked shellfish really is safer. Protect your health and skip the raw oyster bar.

Hand Washing

Hepatitis A is a hearty virus that is capable of being viable outside of the body for up to several months. It is critical to practice good hygiene to reduce your risk of contracting hepatitis A. Wash your hands thoroughly after using the restroom. Carry hand sanitizer with you and use it frequently throughout the day if washing with soap and water is not available. It is especially important to wash your hands before eating or preparing food. Avoid touching faucets, toilet flush handles, and door handles in public restrooms. Flush the toilet with your foot and use a paper towel to turn on and off the faucet and to open the door to minimize your risk of coming into contact with germs.

Contact with Blood

It is possible to contract hepatitis C virus (“hep C”) and hepatitis B from having contact with the body fluids and blood of an infected person. An infected mother may pass the infection to her baby during childbirth. Sex partners may contract the virus from each other. Dental instruments contaminated with infected blood may transmit hepatitis, but sterilization makes this highly unlikely. It is much less likely to contract hep C and hepatitis B from a blood transfusion because the blood supply in the U.S. is screened. However, the risk of contracting these viruses from blood transfusion is not zero. It is estimated that there is about a 1 in 205,000 chance of contracting hepatitis B from a blood transfusion and a 1 in 2 million chance of contracting hepatitis C from a blood transfusion.

Body Art

If you are considering getting a body piercing or tattoo, make sure you choose the shop wisely. Tattoos and body piercing are risk factors for contracting hepatitis C virus and hepatitis B. Ask the staff at the facility how they sterilize the equipment between clients. All tools should be heat-sterilized to kill blood-borne infections after every client. Observe the staff closely. Make sure they wear gloves while piercing or tattooing, and they should wash their hands thoroughly after every client. Staff should put on a new pair of gloves before attending to the next customer.

Nail and Hair Salons

Any time you are exposed to the blood of another person, there is a risk of contracting hepatitis C virus and hepatitis B. The nail salon and hair salon both offer small potential sources of exposure through shared grooming items. Make sure the nail and hair salons you go to thoroughly sterilize and disinfect tools between clients. If you are still concerned, consider bringing your own razors, nail files, nail clippers, and other tools to the shop.

Sex Partners

Having a sex partner who has hepatitis C virus or hepatitis B is a major contributor to new infections. Hepatitis B and C viruses can reside in the vaginal fluid, blood, or semen of an infected person. Abstinence is the only surefire way to avoid contracting hepatitis from an infected person. There is a vaccine for hepatitis B. Use latex condoms and/or dental dams every time you have sex to help reduce the risk of being exposed to hepatitis C and hepatitis B viruses. These measures will also help protect you against HIV-infected partners.

Keep Personal Items Personal

Any tools or implements that may have a bit of blood on them from infected people are potential sources of hepatitis B or C transmission. Toothbrushes, nail clippers, razors, needles, and washcloths may all contain trace amounts of blood that can transmit infection. Keep personal items such as these to yourself and never use personal items that belong to others.

Organ Transplantation

All donated blood, organs, and tissues in the U.S. are screened for hepatitis C virus, HIV, and other pathogens prior to being given to recipients. Screening greatly decreases the risk of recipients becoming infected with hepatitis C virus and other blood-to-blood transmitted infections, but it does not eliminate the risk entirely. People who received donated blood or organs prior to 1992 were at increased risk of contracting hepatitis C infection from the donated tissue because that was when widespread screening for the virus was instituted.

Kidney Disease Link

People who have kidney disease and undergo dialysis, especially long-term, are more likely to be infected with hepatitis B and hepatitis C. One study found that having chronic hepatitis C infection was associated with a 43 percent increase in the incidence of chronic kidney disease. The chronic HCV-infected who also have chronic kidney disease are also more likely to develop end-stage renal disease and have higher all-cause mortality when undergoing dialysis.

Baby Boomers

People born in the baby boom generation between 1945 to 1965 are 5 times more likely to have HCV infection than other adults. Although anyone of any age can contract hepatitis C, approximately 75 percent of people who have it were born during the baby boom. Transmission of the virus was highest from the 1960s to the 1980s. Many people may have become infected from medical procedures before precautions to guard against transmission of blood-borne pathogens were in place. Others may have been infected by receiving blood transfusions before adequate screening was in place. Intravenous drug use and needle sharing is another potential source of infection. The majority of people who have hepatitis C do not know that they have it. People often live with chronic infection for many years without exhibiting symptoms. This is dangerous because HCV-related risks include increased incidence of liver disease, liver cancer, and the need for liver transplantation. The earlier that HCV infection is diagnosed and treated, the better. The U.S. Preventive Services Task Force recommends that all baby boomers be screened at least once for HCV.

At-Risk Professionals

Health-care professionals like surgeons, dentists, infusion nurses, and other medical workers who may suffer needlestick injuries and come into contact with blood are at increased risk of contracting hepatitis C virus. Any health-care professional who suffers a needlestick or other exposure to a patient’s blood should be tested for hepatitis C and watch for symptoms of acute hepatitis C infection like fatigue, fever, clay-colored stool, abdominal pain, joint pain, jaundice, nausea, vomiting, dark urine, and loss of appetite. Approximately 75 to 85 percent of people who are infected with HCV go on to develop chronic hepatitis C infection. Several blood tests are available to detect HCV infection. Some of these tests check for antibodies (anti-HCV). Some blood tests check for the presence of HCV genetic material. Some blood tests check for the amount of virus in the body (viral load).

HIV Infection

HIV and HCV are both blood-borne infections that are spread by blood-to-blood contact. Approximately 25 percent of people who are infected with HIV are co-infected with hepatitis C. HIV and hepatitis C co-infection is present in approximately 50 to 90 percent of HIV-infected injection drug users. People who have both infections are more likely to progress to liver damage compared to those who just have HCV infection. Infection with HCV affects the way that HIV is managed, too. It is recommended that everyone who has HIV should be screened for HCV infection.

Reviewed by Melissa Conrad Stöppler, MD

Hepatitis C (Hep C) Symptoms and Treatment

What Is Hepatitis C (Hep C, HCV)?

Hepatitis C (HCV) is a virus that causes inflammation of the liver. Hepatitis means inflammation of the liver. It is a member of the family of viruses that include hepatitis A and hepatitis B. The viruses behave differently and have different modes of transmission. Hepatitis C can cause serious liver damage, liver failure, liver cancer, and even death.

How Common Is Hepatitis C?

About 2.7-3.9 million people in the U.S. currently live with chronic hepatitis C infection. 75%-85% of people infected with hepatitis C are infected with chronic hepatitis C. The virus is most common in baby boomers who represent 75% of infected adults. The rates of hepatitis C were the highest in the 1970s and 1980s, the time when many baby boomers were likely infected. Many people who have hepatitis C don’t know they have it because the virus may not produce symptoms until decades after infection.

 

Hepatitis C in Children

Hepatitis C is less common in children, but there are approximately 23,000-46,000 children in the U.S. with hepatitis C. Most children are infected by hepatitis C at birth. A child has a 1 in 20 chance of being infected if the mother has hepatitis C. Adolescents can be infected with hepatitis C by exposing themselves to IV drug use, sharing needles, and high-risk sexual behaviors. Up to 40% of hepatitis C cases in children will go away on their own by age 2, if the virus is transmitted at birth.

How Do You Get Hepatitis C?

Hepatitis C is a blood-borne illness, meaning it is transmitted via contact with infected blood. Usually the virus enters the body through a puncture wound on the skin.

 

Is Hepatitis C Contagious?

Yes, hepatitis C is contagious. The most common way hepatitis C is transmitted is via injection drug use. Sharing needles with someone who is infected can transmit hepatitis C. Health care professionals may contract the virus via needlestick injury. Prior to 1992, the U.S. blood supply was not screened the way it is today, so some people contracted hepatitis C from infected blood transfusions. Rarely, babies born to hepatitis C-infected mothers acquire the virus. Hepatitis C can also be spread by having sex with an infected person or sharing personal items (a razor or toothbrush) with someone who has the virus, but these cases are rare.

Hepatitis C (Hep C) Symptoms

About 70% to 80% of people with the hepatitis C virus do not have any symptoms, especially in the early stages. In these people, symptoms may develop years, even decades later, when liver damage occurs. Others develop symptoms between 2 weeks to 6 months after infection. The average time to develop symptoms is 6 to 7 weeks after acquiring the virus. A person who has hepatitis C infection, but isn’t exhibiting any symptoms can still pass the virus on to others. Hepatitis C symptoms may include:

  • Mild-to-severe fever
  • Fatigue
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Joint pain
  • Dark urine
  • Clay-colored stool
  • Yellowing of the skin (jaundice)

Acute vs. Chronic Hepatitis C Infection

Acute hepatitis C infection refers to symptoms that appear within 6 months of newly acquiring the virus. About 20% to 30% of those who acquire hepatitis C experience acute illness. After this, the body either clears the virus or goes on to develop chronic infection.

Chronic hepatitis C infection refers to long-lasting infection. The majority of people who have acute hepatitis C infection (75% to 85%) go on to develop the chronic form of the illness.

How Is Hepatitis C Diagnosed?

Hepatitis C infection is diagnosed with several blood tests. The hepatitis C antibody test checks for antibodies (immune particles) that fight the virus. A “non-reactive” result means that antibodies to the virus are not detected. A “reactive” result means antibodies to the virus are present, but the test is unable to indicate whether the infection is current or from the past. Another blood test to assess the presence of hepatitis C genetic material (HCV RNA test) is available. The results of this test can help doctors determine whether hepatitis C infection is current or not. Additional blood tests can be used to determine the amount of virus in the body, known as a titer.

When someone has confirmed hepatitis C infection, the doctor will order more tests to assess the degree of liver damage. A liver biopsy may be performed. There are several different strains of the hepatitis C virus that respond to different treatments. For this reason, the doctor will order a test to determine the genotype(s) of the hepatitis C infection to help determine the course of treatment.

 

Who Should Get Tested for Hepatitis C?

  • Current or former drug users who use needles
  • Healthcare workers exposed to blood or bodily fluids
  • People with a sex partner infected with chronic hepatitis C
  • People who had their blood filtered by a machine for a long time
  • People who received a blood transfusion or organ transplant from a donor before July 1992
  • People with HIV
  • People born between 1945 and 1965

Potential Hepatitis C Complications

Chronic hepatitis C infection is a long-lasting illness with potentially serious complications. About 75% to 85% of those with acute hepatitis C infection go on to develop chronic hepatitis C. Of those in the chronic illness group, more than two-thirds will develop liver disease. Up to 20% will develop cirrhosis, or scarring of the liver, within 20 to 30 years. Cirrhosis affects liver function and causes elevated blood liver enzymes. Up to 5% of people with chronic hepatitis C infection will die from liver cancer or cirrhosis. Chronic hepatitis C infection is the most common reason for liver transplantation in the U.S.

Hepatitis C (Hep C) Treatment

Treatment for hepatitis C is available. The course of treatment depends on whether the infection is acute or chronic, the strain (genotype) of the virus, the amount of the virus in the body (viral load), the degree of liver damage, response to previous treatment, and the health of the patient. Hepatitis C treatment is highly individualized, so it’s important to be under the care of a doctor with expertise in this area. The goal of treatment is to achieve sustained virologic response (SVR), which means there is no detectable virus in the blood 6 months after treatment. While it’s not a cure, achieving SVR is the next best thing. Many people with hepatitis C can achieve SVR with treatment.

 

Medications That Treat Hepatitis C

  • Interferon (Infergen, Roferon, Intron A)
  • Peglyated interferon (Pegasys, Pegintron)
  • Ribavirin (CoPegus, Rebetol)
  • Boceprevir (Victrelis)
  • Telaprevir (Incivek)
  • Simprevir (Olysio)
  • Sofosbuvir (Sovaldi)
  • Ledipasvir/sofosbuvir (Harvoni)
  • Ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets (Viekira Pak)
  • Ombitasvir/paritaprevir/ritonavir (Technivie)
  • Daclatasvir (Daklinza)

Your doctor can choose the best treatment for your individual circumstances.

Hepatitis C and Liver Transplantation

Some people with advanced hepatitis C and severe liver damage undergo a liver transplant, but that doesn’t eradicate the infection. Patients with an active infection at the time of the transplant will develop hepatitis C in the new liver. Sometimes the infection recurs even when patients are on antiviral treatment. Those who have achieved sustained virologic response (SVR) – meaning no detectable virus in the blood 6 months after treatment – have a very low risk of developing hepatitis C infection in the new liver.

Is Hepatitis C Curable?

About 15% to 25% of people who are infected with the hepatitis C infection clear the virus on their own. Scientists are still trying to determine why hepatitis C goes away in some patients, while others go on to develop symptoms. There is no cure for an active or chronic hepatitis C infection, but sustained virologic response (SVR) is the next best thing. Hepatitis C infection rarely recurs in those who have achieved SVR.

Hepatitis C Vaccine

There is currently no vaccine for hepatitis C. Research is ongoing to develop a vaccine against the virus. There are vaccines for hepatitis A and hepatitis B.

How to Prevent Hepatitis C Infection

Hepatitis C is a blood-borne infection. To reduce the risk of infection, avoid sharing personal items (toothbrushes and razors) with others. Do not use injected drugs. If you do use injected drugs, never share needles and equipment with others. Getting tattoos and body piercings can put you at risk. Use condoms during sex. Health care workers should take precautions to avoid needle-sticks and properly dispose of needles and other materials that come into contact with blood. Speak to your doctor about your risk factors and follow recommended screening standards for hepatitis C.

 

How to Prevent Giving Hepatitis C

If you have hepatitis C, these common precautions should be followed to prevent spreading or giving hepatitis C to others:

  • Cover cuts and blisters
  • Properly dispose of any used bandages, tissues, tampons, or anything else containing your blood
  • Wash your hands or any objects that have come in contact with your blood
  • Clean spilled blood on surfaces with household bleach and water
  • Don’t share personal items that have your blood on it
  • Do not breastfeed if your nipples becomes cracked and bleed
  • Do not donate blood, sperm, or organs

Reviewed by Charles Patrick Davis, MD, PhD

 

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