Hepatitis

Hepatitis is an inflammation of the liver usually caused by a virus or, less often, by certain medications or chemical agents, such as alcohol, carbon tetrachloride, and large amounts of panadol. The Hepatitis B and C viruses have infected 520 million people globally, many are infected with a hepatitis virus but have no symptoms.

The three most common types of hepatitis are labeled A, B, and C. Hepatitis A (HAV) is the most common form and is transmitted mainly by contaminated food or water. Most people recover completely from a hepatitis A infection although it can take up to six weeks for recovery.

Hepatitis B virus (HBV) is more serious than hepatitis A and can cause permanent liver damage. This infection is usually acquired through exposure to contaminated blood. Intravenous drug users who share contaminated needles are at highest risk, but persons who have multiple sexual partners, people who are healthcare workers, people who have repeated blood transfusions, and persons who need dialysis to maintain kidney function are also at risk. New blood donor screening tests have greatly reduced the dangers of blood transfusions, and a vaccine is available for people who are likely to come in contact with the virus.

Hepatitis C (HCV) is the form that causes the most serious lifelong problems. It is usually spread through exposure to contaminated blood or needles, often through body piercing or tattooing, or through sexual contact with someone who has the infection. Many people have the hepatitis C virus in their bodies, but most of them have no symptoms and are not aware of their risk for progressive liver disease. HCV can cause serious conditions and are the main reason people need liver transplants.

Some individuals who carry HBV and HCV can progress to further, serious liver conditions, including liver cirrhosis and liver cancer.

Hepatitis D (HDV), also called the delta agent, is a defective virus that requires the presence of hepatitis B for its expression and infection. It may be present when a person contracts HBV in a ‘co-infection’, or may be contracted later and cause a ‘superinfection’.

Hepatitis E is also called epidemic hepatitis. It shares many similarities with HAV and is responsible for waterborne hepatitis outbreaks in India, Burma, Afghanistan, Algeria, Mexico, and recently Sudan and Iraq.

In 1995, a new virus that causes hepatitis was discovered. It is known as the GB agent, so named after the initials of a surgeon who contracted this infection. Hepatitis G (HGV) is mild and does not commonly cause serious liver damage, yet it accounts for 9% of all hepatitis infections. HGV has been recently identified as a group of three virus sub-types of HCV.

Viral hepatitis occurs less commonly with other viral etiologies such as Epstein-Barr virus, cytomegalovirus, adenovirus, herpes simplex and the Coxsackie virus. Other types of hepatitis occur depending on the cause, but many of the manifestations are the same. Alcoholic hepatitis can follow a binge of ethanol consumption, or long term chronic alcohol abuse. Drug induced hepatitis can be caused by a number of pharmacological medications, such as methyldopa (for heart conditions), isoniazid (to treat TB) and panadol. Chronic autoimmune hepatitis is a chronic hepatitis of unknown origin that predominantly affects young and middle aged women.

Most people recover from hepatitis infections with no special treatment, although some become carriers of the infection. The term chronic hepatitis means active, ongoing inflammation of the liver persisting for more than six months that is detectable by biochemical and histologic means. It most commonly happens with HBV and HCV infections.

The symptoms of Hepatitis

It can be very difficult to tell the forms of hepatitis apart by their symptoms. Many people think they have the flu because of the fatigue, abdominal pain, loss of appetite, nausea, and vomiting that may occur at the initial stages of any hepatitis infection. The liver may be enlarged, causing abdominal tenderness with chronic diarrhea. Yellow skin (jaundice) and dark-colored urine can be important clues to a liver problem. For people that may have a chronic form of hepatitis, red palms and spider veins around the umbilicus may be present. Skin rashes and itching are also signs of a chronic condition. In males, a chronic condition can lead to gynoecomastia, which is when the male body starts to look more female, i.e. with breasts. Many people, especially those with HCV, will have no overt symptoms and the infection is found during a routine blood test.

Diagnosis and Pharmaceutical Interventions

After a through history and physical examination, evaluation of the liver conditions and hepatitis are done via blood tests. Most form of hepatitis and other liver conditions will show elevated liver functions test (LFTs), which are enzyme markers (tranferases) and sensitive indicators of liver cell injury. An elevated bilirubin is also indicates a problem with the liver or gallbladder. A high reading on these tests may lead to further testing specific to liver. Many people with HCV will reveal normal LFTs.

HAV is diagnosed by quantitatively detecting the levels of the IgM antibody, produced by the body against the virus, in the blood. Hepatitis B is diagnosed by detecting the level of viral antigen in the blood, which should decrease after a certain time and if not, a chronic carrier state can develop. While this antigen is still in the blood, a person can still spread the disease even thought they may feel well. When HBV carriers create the specific antibody to the antigen (Anti-HBs), recovery can be complete. While HDV is associated exclusively with HBV it may be recommended to test for it as well, diagnosis is made by detection of antibody to hepatitis D antigen (anti-HDV) or, where available, HDV RNA in serum.

HCV is also detected via a blood test of the viral antigen. Since some people will have normal LFTs, a careful history in needed for practitioners to suspect and order additional testing. A history of intravenous drug use, hemophilia, or even the receiving of a tattoo can be an indicator for a more through evaluation.

Pharmaceutical medications

In HAV immune globulin is recommended to all close (e.g., household) personal contacts of patients with hepatitis A and should be considered in persons who consume food prepared by an infected food handler. Hepatitis B immune globulin (HBIG) may be protective ¬or may attenuate the severity of illness ¬if given in large doses within 7 days after exposure followed by initiation of the HBV vaccine series (see below). This approach is currently recommended for persons exposed to HBsAg-contaminated material via mucous membranes or through breaks in the skin and for individuals who have had sexual contact with persons with HBV infection. HBIG is also indicated for newborn infants of HBsAg-positive mothers followed by initiation of the vaccine series.

Treatment of acute hepatitis C patients with interferon alfa or peginterferon for 6–24 weeks appreciably decreases the risk of chronic hepatitis. Ribavirin may be added if HCV RNA fails to clear after 3 months of interferon alpha or peginterferon. Alpha Interferon is a synthetic copy of the natural interferon, and is used for more severe cases or as a pre-emptive strike. Interferon treatment may only be effective in 50% of cases. It can cause flu-like symptoms and depression; it is currently the main treatment. Experts are suggesting to those who are diagnosed early, that they start an aggressive treatment course lasting twelve to eighteen months regardless of symptoms.

Lifestyle and Dietary Modifications

Any number of factors may set off or trigger a dormant hepatitis virus, such as a drinking binge, exposure to toxic chemicals, over dosage of prescription or over-the-counter medications. Patients with chronic hepatitis should avoid alcohol at all cost. The breakdown of alcohol can create toxic products which seem to speed progression of liver disease. Alcohol by itself contributes to cirrhosis of the liver, which a small percentage of chronic carriers of the HBV and HCV are at risk for as well.

Obesity is associated with increased liver problems in chronic hepatitis. The increased body size contributes to a higher workload on the liver.

Smoking is associated with increased risk of hepatocellular cancer (HCC) in patients with HCV. Cigarette smoke contains over 200 known carcinogens.

Stress and a depleted immune system can contribute to the progression to a chronic form of liver disease. Relaxation techniques including yoga and exercise are beneficial.

High amounts of iron can accelerate oxidative damage to the liver in HCV, and should be avoided. Some research has even looked at therapeutic phlebotomy (the drawing of blood) for these patients. People who failed to respond to interferon therapy have been found to have a higher amount of iron within the liver. People with HCV should, therefore, avoid iron supplements

High fat diets have been correlated with increased risk of progression to liver failure. Many high fat diets also contain a high amount of processed foods, such as coffee, chocolate, sugar, greasy, fatty and fried foods.

A variety of prescription drugs can, on rare occasions, cause hepatitis, as can large amounts of niacin or niacinamide (forms of vitamin B3). Excessive intake of acetaminophen or other painkillers can damage the liver, so excessive intake of these drugs should be avoided.

People with any type of hepatitis should ask their physician whether any medication they are taking poses a risk to the liver.

For infectious (viral) hepatitis, good hygiene is necessary to avoid spreading the infection. The hepatitis A virus can be spread very easily through food that is handled by infected individuals; therefore, people with hepatitis A should wash their hands very carefully after using the restroom and should not handle food at work. The hepatitis viruses B and C are both transmitted by blood and sexual contact. Cover wounds that could expose others to your blood, and never share toothbrushes or razors. Be sure to tell your healthcare providers about any past hepatitis infections. And always have practice safe sex.

Nutritional Factors Shown to be Beneficial

Vitamin E

Vitamin E levels have been shown to be low in people with hepatitis as well as in those who later develop liver cancer from long-standing hepatitis. Supplementation of this vitamin can decrease the risk of liver fibrosis of those with chronic disease.
Dose: 600-1200 IU

Minor Buplerum formula

This herbal formula is called Chai Hu Xiao Tang in China or in Japanese Sho-saiko-to. Its main ingredient is the Bupleurum falcatum although it is thought that the combination of herbs is responsible for it efficacy. I t has shown to reduce the incidence of liver cancer in HBV and can reduce live rblood enzyme levels. It has also shown benefit with HCV. It should not be used together with interferon drug therapy as it may increase risk of pneumonitis – a potentially dangerous inflammation in the lungs and it may increase the side effects of the drug, as it stimulates the body’s own interferon.
Dose: 2.5 g three times a day

Phyllanthus (Phyllanthus amarus)

Phyllanthus, an Ayurvedic herb, has used traditionally to support the liver, skin and other chronic conditions. It has been studied with some successful outcomes in carriers of the hepatitis B virus.
Dose: ranged from 900–2,700 mg per day.

Milk Thistle (Silybum marianum)

Silymarin, the flavonoid extracted from milk thistle, has been studied for treating all types of liver disease. It has been shown to decrease fibrosis.
Dose: 420 mg of silymarin per day.

Schizandra chinensis

Research suggests that compounds called lignans in schisandra promote regeneration of liver. Schizandra protects the liver against toxic chemical damage even when activated into a poison, in the liver, such as with carbon tetrachloride.
Dose: 500 mg two to three times a day

Alpha-Lipoic Acid

Alpha lipoic acid is an antioxidant that increases the body’s availability of glutathione, a necessary compound for detoxification. This supports the liver functions and can possibly reduce liver cell damage.
Dose: 300 mg twice a day

Selenium

Selenium is a mineral that supports the immune system, can help prevent the progression of hepatitis to more serious health conditions.
Dose: 200 mcg three times a day

N-acetyl-cysteine (NAC)

NAC has been used to treat viral hepatitis as well as is used to treat conditions from panadol poisonings. It also recycles glutathione which is low in people with hepatitis.
Dose: 1800 mg a day

Vitamin C

Vitamin C can help reduce the toxic load in the liver by chelating the iron that can build up and contribute to lack of clinical response to treatment.
Dose: 2-8 g a day

Betaine

Betaine, also called Trimethylglycine (TMG) helps to prevent alcohol induced Fatty Liver by decreasing liver cell damage.
Dose: 3-6 g/ day