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What is hepatitis?

Read more about hepatitis - an inflammatory condition of the liver

Hepatitis is the inflammation of the liver and is commonly caused by a virus infection but can also be caused an autoimmune condition or as a result of toxins in the body such as alcohol or drugs. Hepatitis may be acute, in which is lasts less than six months, or chronic where the inflammation lasts longer than six months. There are 5 different types of viral hepatitis, but viral hepatitis A, B and C are the most common.

Usually, acute hepatitis often presents no noticeable symptoms, but if symptoms do develop, they can include the following:

  • Yellowing of the eyes and skin (jaundice)
  • Fatigue
  • Flu-like symptoms
  • Pale stools
  • Dark urine 
  • Unexplained weight loss 
  • Joint and muscle pains
  • Abdominal pain
  • Loss of appetite 

What is hepatitis A?

Hepatitis A is an acute, short-term disease caused by the hepatitis A virus (HAV). Hepatitis A is commonly transmitted by through food or water which has been contaminated by faeces from someone who is already infected by the virus. This type of hepatitis is most common in countries where the sanitation is poor. As hepatitis A is an acute infection, it usually passes within a few months, but sometimes it can be severe. For this particular viral infection, there is no treatment available other than relieving the symptoms such as itching and nausea. A vaccination against hepatitis A is available for people at a high risk of infection. 

How is hepatitis A diagnosed?

When liver cells are damaged by infection or inflammation, they leak their contents into the blood. Liver cells have two enzymes, aspartate transferase (AST) and alanine transferase (ALT) which are present in much higher concentrations than they are in the blood.

When the liver is damaged, a rise in AST and ALT can be detected in the blood. However, this is not very specific because damage to the muscles (e.g. following exercise) can also elevate the levels of AST in the blood. Although an increase in both AST and ALT indicates the liver cells are damaged, this increase alone doesn't explain what the cause of the damage is.

To discover whether the hepatitis A virus is responsible for the liver damage, a blood test looking for antibodies against the virus is required. When presented with a new infection, the body makes immunoglobulin M (IgM) antibodies against the virus - these are the body’s first line of defence. As the immune system learns to combat the virus it produces Immunoglobulin G (IgG) antibodies. Therefore, when a blood test is performed, a current viral infection will show elevated IgM levels in the blood, whilst a previous infection will show elevated IgG levels. This approach works for simple illnesses like hepatitis A and E which don’t have the potential to cause long-term infection.

What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus (HBV) and is transmitted through contact with infectious body fluids of an infected individual, such as blood, semen or vaginal secretions. The virus can be passed from an infected pregnant woman to their baby and spread by having unprotected sex with an infected partner. If an adult is infected with the hepatitis B virus, usually they can fight it off and recover within a couple of months. However, if a child is infected, they usually develop a long-term infection - chronic hepatitis B, which can eventually lead to scarring of the liver and liver cancer. For the hepatitis B virus, antiviral medication is available. A vaccination against hepatitis B is also available and is offered to those who are at risk of being exposed to the virus. The hepatitis B vaccine is included in the routine immunisation programme in the UK to allow all children to benefit from the viral protection. 

If symptoms do develop, they tend to occur a couple of months after exposure to the hepatitis B virus.

How is hepatitis B diagnosed?

With hepatitis viruses which can cause a long-term infection, such as hepatitis B or C, a blood test looking for proteins from the surface of the virus can be useful, as can looking for the virus’ DNA.

Also, because many people have been immunised against hepatitis B, it is important to be able to differentiate between a previous infection from current infection.

Hepatitis B surface antigen (HBsAg) - A positive result for the HBsAg antigen shows a person is infected with the hepatitis B virus and can spread the virus to others through their blood. Testing for the HBsAg antigen alone is not enough to determine if the infection is acute or chronic.  

Hepatitis B surface antibody (HBsAb) - A positive result for the HBsAb antibody shows a person is protected/immune against the hepatitis B virus and therefore unable to spread the virus to others. This protection may be the result of the hepatitis B vaccine or a successful recovery from a past hepatitis B infection. This test is not routinely included in blood bank screenings. 

Hepatitis B core antibody (HBcAb) - A positive result for the HBcAb antibody shows a past or current hepatitis B infection. Unlike a positive result for the HBsAb antibody, the hepatitis B core antibody does not provide protection against the hepatitis B virus. But without testing for both the HBsAg and anti-HBs, the positive HBaAb result cannot be fully understood. 

What is hepatitis C?

Within the UK, hepatitis C (HCV) is the most common type of viral hepatitis and similarly to hepatitis B, is spread through blood-to- blood contact with an infected individual. It is thought that recreational drug use and the sharing of needles play a large part in the spread of the virus. Hepatitis C is usually a chronic infection as for the majority of those infected with HCV, the virus will remain in the body for a number of years. Although currently there is no HCV vaccine available, hepatitis C can be treated with antiviral drugs. 

What are the symptoms of hepatitis C?

Hepatitis C doesn't often have any noticeable symptoms until the liver is significantly damaged. Because of this, many of those infected are unaware they have the virus. 

Because these symptoms may also indicate a range of other health issues, the only way to know for certain if you are infected with hepatitis C is to have a blood test. 

How is hepatitis C diagnosed?

When a virus enters the body, the immune system works hard to produce antibodies to fight the infection. A positive result from a hepatitis C antibody test indicates whether an individual has ever been exposed to HCV. But this positive result does not necessarily mean there is a current infection as the immune system may have cleared the virus from the body. A second blood test called a PCR test is required after a positive result in order to confirm a current infection.

You can test your blood for the presence of Hepatits with a Hepititis A, B and C Profile Blood Test