Viral Hepatitis

The hepatitis viruses compared

Symptoms

Acute hepatitis

Symptoms appear 2 weeks to 6 months after exposure, depending on the virus:

• tiredness and feeling unwell
• loss of appetite, nausea and vomiting
• fever
• pain or discomfort under the right ribs
• jaundice: yellow skin and eyes
• dark urine and pale, clay-colored stools
• joint pain and itching

Many people, especially children and those with hepatitis C, have no symptoms.

Chronic hepatitis

Chronic hepatitis B and C usually cause no symptoms for years or decades. Tiredness may be the only sign. Eventually, liver scarring can lead to cirrhosis, with fluid in the belly, swelling, confusion, bleeding and liver cancer.

Who should be tested

The CDC recommends:

• hepatitis C testing at least once for all adults 18 and older, and during every pregnancy; regular testing for people who inject drugs
• hepatitis B testing at least once for all adults 18 and older, and during every pregnancy
• testing for anyone with abnormal liver tests, HIV, people on dialysis, and people born in regions where hepatitis B is common

Diagnosis

• liver blood tests: ALT and AST rise with inflammation; bilirubin with jaundice
• viral tests: - hepatitis A: IgM antibody - hepatitis B: surface antigen (HBsAg), antibodies and viral DNA - hepatitis C: antibody, then HCV RNA to confirm current infection - hepatitis D: antibody in people with hepatitis B - hepatitis E: IgM antibody or RNA
• liver scarring assessment: elastography (FibroScan) or blood-based scores
• ultrasound for liver structure and cancer screening in cirrhosis or high-risk hepatitis B

Treatment

Acute hepatitis A and E

Rest, fluids and avoiding alcohol and liver-toxic medicines. Most people recover fully within weeks to a few months. Acetaminophen (paracetamol) can be used at reduced doses on medical advice.

Hepatitis B

Not everyone needs treatment. Antiviral tablets such as tenofovir or entecavir suppress the virus when there is active liver inflammation, significant scarring or high viral levels. Treatment is often long-term. See hepatitis B.

Hepatitis C

Direct-acting antiviral tablets (such as sofosbuvir-velpatasvir or glecaprevir-pibrentasvir) taken for 8 to 12 weeks cure more than 95% of people with few side effects. See hepatitis C.

Hepatitis D

Treatment is difficult; pegylated interferon or newer agents are used under specialist care. Preventing hepatitis B prevents hepatitis D.

Liver protection for everyone

• avoid alcohol
• get vaccinated against hepatitis A and B if not immune
• maintain a healthy weight
• check all medicines and supplements with your doctor

Prevention

• vaccines: hepatitis A for children and at-risk adults; hepatitis B for infants, children and adults according to current CDC immunization schedules, including adults with risk factors at any age
• hepatitis B immunoglobulin and vaccine for newborns of mothers with hepatitis B
• never share needles, razors or toothbrushes
• use condoms
• wash hands and drink safe water when traveling
• choose licensed tattoo and piercing studios

Frequently asked questions

What is the difference between hepatitis A, B and C?

Hepatitis A spreads through contaminated food or water and causes a short-term illness. Hepatitis B spreads through blood, sex and from mother to baby and can become chronic. Hepatitis C spreads mainly through blood, often becomes chronic and can be cured with medicine.

What are the first signs of viral hepatitis?

Early signs include tiredness, loss of appetite, nausea, mild fever and discomfort under the right ribs, followed in some people by dark urine, pale stools and yellow skin or eyes. Many people, especially with hepatitis C, have no symptoms.

Can hepatitis be cured?

Hepatitis C can be cured in over 95% of people with 8 to 12 weeks of tablets. Hepatitis A and E usually clear on their own. Chronic hepatitis B can be controlled with long-term antivirals but is rarely cured.

Is viral hepatitis contagious?

Yes. Hepatitis A and E spread through the fecal-oral route, such as contaminated food or water. Hepatitis B, C and D spread through blood and, for B, sexual contact and from mother to baby. Vaccination and safe practices prevent most spread.