Which Types of Hepatitis Have Higher Complications?
Understanding What’s Worse in Terms of Curability
Medically reviewed by Jay N. Yepuri, MD
Hepatitis is a disease that causes inflammation of the liver. It can be caused by one of five contagious viruses. It can also occur as a result of other factors like alcohol, certain drugs, and some health problems.
This article describes the different types of viral and nonviral hepatitis. It also explains how the types of disease differ by symptoms, treatment, and prognosis.
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Comparing Types of Viral Hepatitis
There are five types of viral hepatitis. They are all considered contagious, though the modes of transmission from one person to another vary by the type of hepatitis involved. Each one is linked with a different type of hepatovirus, a type of virus that targets hepatocytes (liver cells).
The types of viral hepatitis include:
Hepatitis A
Hepatitis A is:
Caused by the hepatitis A virus (HAV)
Primarily transmitted via consumption of contaminated water or food
Hepatitis B
Hepatitis B is:
Caused by the hepatitis B virus (HBV)
Primarily transmitted through exposure to infected blood, semen, and other body fluids
Hepatitis C
Hepatitis C is:
Caused by the hepatitis C virus (HCV)
Primarily transmitted through exposure to infected blood
Hepatitis D
Hepatitis D is:
Caused by the hepatitis D virus (HDV)
Only occurs in people who are infected with HBV
Primarily transmitted through exposure to infected blood, semen, and other body fluids
Hepatitis E
Hepatitis E is:
Caused by the hepatitis E virus (HEV)
Primarily transmitted via consumption of contaminated water or food
Takeaway
Hepatitis A, hepatitis B, and hepatitis C are the most common types of viral hepatitis in the United States.
Vaccination Availability
Vaccinations are available for the prevention of hepatitis A and B but not types C, D, or E. There is also a combination vaccine for the prevention of hepatitis A and B.
Hepatitis A Vaccine
The hepatitis A vaccine is 94% to 100% effective in preventing the disease. It protects you within two to four weeks after your first immunization. The second injection, administered at least six months after your first dose, provides long-term protection.
The Centers for Disease Control and Prevention (CDC) recommends that the hepatitis A vaccine be administered to the following groups:
All children:
First dose at 12 through 23 months old
Second dose at least six months after the first dose
Infants 6 months through 11 months old traveling outside the United States:
First dose before travel
Two additional doses at the recommended ages for long-lasting protection
People in the following groups not previously immunized against hepatitis A during the recommended period should be vaccinated as soon as possible:
Children and adolescents age 2 through 18 years
Adults, especially those whose lifestyle includes risk factors for hepatitis A, including international travelers and those who anticipate close contact with an international adoptee, men who have sexual contact with other men, people with Human immunodeficiency virus (HIV) or chronic liver disease, people who use injection or non-injection drugs, and people who have an occupational risk for infection such as healthcare workers
Hepatitis B Vaccine
The hepatitis B vaccine offers 80% to 100% protection against infection from HBV. It is included in the routine vaccine schedule for all people in the United States. This vaccine can be given alone or as part of a combination vaccine (a vaccine that combines more than one vaccine so they can be given in one injection).
Hepatitis B also protects against future hepatitis D infection since hepatitis D occurs only in people who are infected with hepatitis B.
The CDC recommends the hepatitis B vaccine for the following groups:
All infants (first dose: within 24 hours of birth; second dose: one to two months after the first dose; third dose: six months after the second dose, typically between ages 6 and 18 months)
All unvaccinated children and adolescents younger than 19 years old
Adults aged 19 through 59 years
Unvaccinated adults aged 60 years and older who have risk factors for hepatitis B, which include people born in countries where hepatitis B is common, people with hepatitis C, HIV infection, or sexually transmitted infections (STIs), sex partners or those who live with someone with hepatitis B, people who have been incarcerated, people on dialysis, and men who have sex with men
Adults who need the hepatitis A and hepatitis B vaccines may benefit from a combination vaccine called Twinrix. It is administered as one vaccine in three doses over six months. Consult your healthcare provider to determine whether this type of vaccine is right for you.
Chronic Symptoms
Chronic hepatitis symptoms occur when your liver remains inflamed for at least six months and can't clear the hepatitis virus from your body. It can damage or even destroy liver cells. This can prevent your body from processing essential nutrients and clearing toxins, increasing your risk of cirrhosis (scarring of your liver) and liver cancer.
Chronic symptoms are most commonly related to hepatitis B or hepatitis C. These symptoms typically develop slowly and may not be noticeable until the condition progresses and cirrhosis occurs.
Early-stage chronic symptoms are usually subtle and may be overlooked or attributed to an unrelated condition. Chronic symptoms include the following:
Low-grade fever
Loss of appetite
Mild discomfort in your upper abdomen
Malaise (an overall feeling of illness)
Chronic symptoms can become more profound once chronic hepatitis has progressed and your liver is permanently scarred. Symptoms at this stage can include:
Enlarged spleen
Ascites (a buildup of fluid in your abdomen)
Jaundice (yellowing of your skin and whites of your eyes)
Light-colored stools
Spider angiomas (small, spiderlike blood vessels visible through your skin)
Coagulopathy (a tendency to bleed easily)
Redness in your palms
Itchiness
Hepatic encephalopathy (impaired brain function)
Prognosis
Your prognosis with viral hepatitis depends on the type of virus you have. Additional factors such as your age and other chronic conditions can also impact your prognosis.
Hepatitis A
There is no treatment for hepatitis A. However, the prognosis for someone with hepatitis A is typically excellent. The disease does not cause chronic hepatitis or lasting damage after recovery.
Most people with hepatitis A recover within three months. Almost everyone with this disease gets better within six months. If you have hepatitis A, you become immune to hepatitis A virus for life.
Hepatitis B
Acute hepatitis B typically resolves within two to three weeks. For most people, it takes about four to six months for the liver to return to normal.
Most people, especially those who get infected with hepatitis B in adulthood, can combat the disease without treatment. Only a small number of adults who get hepatitis B develop the chronic disease.
The younger you are at the time of a hepatitis B infection, the more likely you are to develop the chronic condition. Almost all newborns and about 50% of children infected with hepatitis B develop the chronic condition. This can lead to serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
Hepatitis C
About 30% of people infected with HCV clear the virus within six months of infection without treatment. However, the remaining 70% develop chronic HCV infection. Between 15% and 30% of people with chronic untreated hepatitis C will develop cirrhosis within 20 years. Having it also increases your risk of liver cancer.
Your prognosis for HCV depends in part on the genotype. There are six HCV genotypes. Each genotype also has subtypes. Most people are infected by a single, dominant genotype. However, you can have a mixed infection with more than one genotype at the same time.
The prognosis of chronic HCV is very good since it can be cured by oral, direct-acting antivirals (DAAs). The choice of which drug to use depends on the genotype of your infection. You can live a normal life with chronic HCV if you are diagnosed and treated before liver damage or other complications occur.
However, some people don't respond to initial treatment and need re-treatment with a different class of medicine. You can also become reinfected or infected with a different genotype.
Hepatitis D
Hepatitis D is considered a satellite virus since it always occurs as a coinfection with HBV. About 5% of people infected with HBV are coinfected with HDV.
Most people can fight off and recover from acute hepatitis D and hepatitis B infections and the viruses go away. However, less than 5% of people with this combination of infections develop chronic infections that do not resolve.
Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver damage and even death. When combined with HBV, chronic HDV generally causes a more aggressive and rapid progression of liver disease than chronic HBV infection alone.
Hepatitis E
The prognosis for most people with hepatitis E is generally very good. Most people with HEV recover completely. The overall case-fatality rate of hepatitis E is 1%.
However, hepatitis E can be a serious illness with mortality reaching 10% to 30% among pregnant women in their third trimester. It can also pose serious health problems for people with preexisting liver disease. Chronic cases and health problems also occur when organ transplant recipients on immunosuppressive therapy are infected with hepatitis E.
Hepatitis Risk in Pregnancy
During pregnancy, all types of viral hepatitis can have significant consequences for mothers and their infants. The great risk for maternal health and the health of the fetus occurs with acute hepatitis A or hepatitis E infection during pregnancy.
The primary risks for hepatitis B virus, hepatitis C virus, and hepatitis D virus are related to the severity of underlying liver disease in the mother and the risk of mother-to-child transmission. Babies infected with the hepatitis B virus are more likely to have chronic hepatitis B.
Comparing Nonviral Types of Hepatitis
Nonviral hepatitis includes the types of hepatitis that are not caused by viral infections. They can be categorized according to the following causes:
Alcoholic hepatitis: Alcoholic hepatitis is liver inflammation caused by excessive and prolonged alcohol consumption. The disease has the following characteristics:
Caused when alcohol damages liver cells, leading to inflammation and in severe cases, cirrhosis
Reversible if alcohol consumption is stopped and your liver can repair itself
Treatment that involves abstinence from alcohol and the initiation of proper nutrition and supportive care
Nonalcoholic hepatitis: Nonalcoholic hepatitis is associated with metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease or NAFLD). This disease is linked to the following conditions:
Autoimmune hepatitis: Autoimmune hepatitis is a long-term or chronic condition in which your body's immune system attacks your liver cells, causing redness, inflammation, and liver damage. There are two types of autoimmune hepatitis:
Type 1 (classic): Type 1 is the most common form of autoimmune hepatitis. It is often linked to an autoimmune disorder such as thyroiditis, Grave's disease, type 1 diabetes, and ulcerative colitis
Type 2: Type 2 is the least common type of autoimmune hepatitis. It most often affects girls between the ages of 2 and 14.
Drug-induced hepatitis: Drug-induced hepatitis is linked with certain medications, toxins, and herbal treatments that cause inflammation and liver damage. It can occur as an adverse reaction to drugs or an overdose. Treatment involves identifying and discontinuing the drug, followed by supportive care.
Common drugs that cause this type of hepatitis include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Advil or Motrin (ibuprofen), Voltaren (diclofenac), and Aleve (naproxen)
Certain antibiotics
Some herbal supplements
Metabolic disorder disease: Metabolic liver disease is a group of inherited and acquired disorders that affect your liver's ability to process and metabolize nutrients. This can result in the accumulation of harmful substances that cause liver inflammation and damage. Treatment involves managing the underlying conditions, along with medications or other treatments as needed.
The most common metabolic diseases include:
Wilson's disease (abnormal copper metabolism)
Alpha-1 antitrypsin (AAT) deficiency (deficiency of a protein that protects your liver)
Ischemic hepatitis: Ischemic hepatitis, also known as shock liver, occurs due to an inadequate supply of blood and oxygen in your liver. It is typically caused by severe low blood pressure or reduced blood flow. Treatment involves addressing the underlying cause and providing supportive care to optimize liver function.
It can be a complication of the following conditions:
Arrhythmia (abnormal heart rhythms)
Severe infections, especially sepsis
Severe bleeding
What Exacerbates Hepatitis?
The following characteristics or risk factors can increase your risk of hepatitis and exacerbate the disease if you become infected:
Being born outside the United States
Using or injecting drugs
Being a man who has sex with men
Diabetes
Hepatitis B
HIV/AIDS
Homelessness
Working in the healthcare industry
Living Well With Hepatitis
Living well with chronic hepatitis is possible if you follow the steps necessary to protect your liver and manage your symptoms. Since hepatitis can affect your physical and emotional well-being, guarding your liver health and slowing the progression of hepatitis requires a multipronged approach.
These strategies can help you protect your liver health and slow disease progression:
Follow up with your healthcare provider every six months or as recommended to monitor your liver health for signs of cirrhosis, liver failure, or liver cancer.
Get the hepatitis A vaccine to protect your liver from another virus.
Since everything you eat, drink, breathe, or absorb through your skin is filtered through your liver, talk to your healthcare provider about the risks involved in using vitamin supplements or herbal treatments, taking any over-the-counter drug such as Tylenol and Advil, and breathing fumes from paint thinners, glues, cleaning products, and other chemicals.
Follow a healthy lifestyle to protect your liver and slow disease progression. This can include avoiding alcohol use and smoking, limiting saturated fats such as those found in fried foods and fatty cuts of meat, limiting foods and drinks with added sugars such as candy and soda, inspecting nuts and grains for signs of mold that could carry aflatoxin, a known risk factor for liver cancer, and avoiding eating raw or undercooked shellfish because they could be contaminated with Vibrio vulnificus, a bacteria that is toxic to your liver.
In addition to protecting the health of your liver, living well with hepatitis also requires managing the emotional aspects of the disease. Living with chronic hepatitis B and hepatitis C can make you feel depressed and isolated.
The following strategies can help you manage the overwhelming emotional aspects of chronic hepatitis:
Talk to your healthcare provider about your feelings.
Take daily walks.
Practice meditation.
Incorporate exercise into your daily routine.
Protecting Others When You Have Hepatitis
If you have chronic hepatitis B or hepatitis C, take the following precautions to prevent those around you from becoming infected:
Have household members and sexual partners tested and vaccinated if they are not infected.
Hepatitis B can be spread through direct contact with blood, unprotected sex, and contact with infected bodily fluids.
Use latex or polyurethane condoms to avoid unprotected sex.
Don't share personal items like razors or needles.
Keep all cuts and open sores covered.
Clean all blood spills with black and water.
Summary
Hepatitis can damage your liver and affect how well it functions. Viral hepatitis is the most common type of this disease. It is caused by one of five contagious viruses, hepatitis virus A, B, C, D, and E. Other factors, such as alcohol, certain health problems, and some drugs can also cause the disease.
Hepatitis can occur as an acute or chronic problem. Chronic hepatitis can lead to severe issues like cirrhosis, liver failure, liver cancer, and a higher mortality risk. Early diagnosis and treatment may help prevent these problems.
Factors such as the mode of transmission and treatment options vary based on the type of virus involved. You can prevent or lower your risk for hepatitis A and B with vaccines. Taking certain safeguards can also reduce your risk of getting infected.
Vaccination against hepatitis A and hepatitis B can protect you from these types. If you think you have been exposed to any type of viral hepatitis or have symptoms of the disease, contact your healthcare provider.
Read the original article on Verywell Health.
