Hepatitis

Hepatitis refers to inflammation of the liver. The causes of hepatitis can vary widely. Viral infections are the most common cause of the liver disease. In these cases, the condition is referred to as viral hepatitis.

Hepatitis is also described as acute or chronic, depending on how long the liver stays inflamed. Liver inflammation that lasts for less than six months is called acute hepatitis, while inflammation that persists for longer than six months is referred to as chronic hepatitis.

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Acute hepatitis may not cause any noticeable symptoms. People therefore may not realize they have it. When present, hepatitis symptoms might include:

• Abdominal pain and/or tenderness, particularly in the upper right corner of the abdomen called the right upper quadrant (RUQ)
• Abdominal bloating or ascites (swelling caused by fluid retention in the abdomen)
• Dark-colored urine and/or light- or clay-colored stools
• Fatigue
• Itching
• Jaundice (yellowing of the skin or whites of the eyes)
• Joint pain
• Loss of appetite
• Low-grade fever (around 99.5 to 100.3 degrees Fahrenheit)
• Malaise (feeling unwell in general)
• Nausea with or without vomiting
• Unexplained weight loss

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The cause of hepatitis varies depending on its type (see below). For instance, the various types of viral hepatitis are caused by several viruses:

• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Hepatitis D virus (HDV)
• Hepatitis E virus (HEV)
• Hepatitis G virus (HGV)

Other known causes of hepatitis include:

• Fatty liver disease
• Genetic disorders such as Wilson disease (a condition that causes copper to build up in the body, especially in the liver and brain)
• An overactive immune system, which mistakenly attacks the liver
• Other viral, bacterial, or parasitic infections
• Liver damage caused by long-term, heavy alcohol use and toxins or poisons such as an overdose of medicines like acetaminophen

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Risk factors vary, depending on the type of hepatitis. In general, a combination of health, lifestyle, and environmental factors contribute to or raise the risk of hepatitis. These might include, but aren’t limited to, factors such as:

• Drinking or using water (such as to brush teeth) contaminated with a hepatitis virus
• Poor hygiene and lack of proper sanitation services
• Using contaminated syringes, needles, and other equipment used to prepare and inject drugs
• Being exposed to toxins that can inflame and damage the liver
• Engaging in unprotected sex with multiple partners who may be infected with the virus
• Heavy alcohol consumption
• Living or traveling to areas where the disease is common (known as endemic areas)
• Using certain drugs or medicines
• Getting a tattoo or body piercing with a needle and/or equipment that’s contaminated with a hepatitis virus
• Being exposed to one or more of the hepatitis viruses, as well as other viruses that can cause liver inflammation

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Most cases of hepatitis diagnosed in the United States are caused by one of the five main types of hepatitis viruses, with hepatitis A, B, and C accounting for the majority of the country’s acute viral cases. Hepatitis D and E occur less often.

Hepatitis severity can vary, depending on what caused it. Some people experience a mild and/or self-limiting course, which means the disease gets better on its own without treatment. Others experience more profound illness that may require a liver transplant.

Hepatitis A

HAV causes hepatitis A, an infection that’s most often transmitted via the fecal-oral route. This means it’s spread by ingesting food or water that has been contaminated with the feces (stool) of an infected person. It is more likely to occur in areas that have poor sanitation. The disease can also pass from person to person during intimate contact such as unprotected sex.

It may take weeks for hepatitis symptoms to appear after being infected with HAV, if they occur at all. These might include flu-like symptoms such as fever, loss of appetite, nausea, and diarrhea. Jaundice may also develop, which can cause yellowing of the skin and eyes, pale stools, and dark urine.

Hepatitis A is an acute form of the disease, meaning symptoms are generally short-lived. That said, acute symptoms may cause severe illness requiring admission to the hospital for treatment.

Those at higher risk for hepatitis A include people who have not been vaccinated against HAV and:

• Live or travel to endemic areas (locations where the disease is common)
• Engage in unprotected sex, particularly oral-anal sex
• Inject drugs with contaminated needles and other drug paraphernalia
• Are exposed to HAV because of their occupation such as nurses, doctors, and lab staff
• Are experiencing homelessness
• Are incarcerated

Hepatitis B

HBV causes hepatitis B. The disease is usually spread through contact with infected body fluids such as blood, saliva, semen, and vaginal fluids. The virus can also be spread via perinatal transmission (from mother to child during childbirth). Babies born to mothers with a high viral load (amount of the virus in the blood) are at higher risk of contracting HBV than those born to mothers with a low viral load.

Those at higher risk for hepatitis B include people who have not been vaccinated against HBV and who:

• Share needles and other drug paraphernalia when injecting drugs
• Work in a healthcare or other setting that exposes them to needles and body fluids, such as blood
• Reuse contaminated needles, syringes, and other sharp objects in the healthcare setting
• Have unprotected sex, particularly those who have multiple sexual partners or men who have sex with men
• Get a tattoo or body piercing with a contaminated needle and equipment
• Live or travel to endemic areas
• Are on long-term dialysis (a treatment that filters waste products, salts, and excess fluids from the blood when the kidneys can no longer perform this function)
• Share contaminated personal items such as razors or toothbrushes
• Have HIV (since it spreads in similar ways as HBV), type 2 diabetes, or hepatitis C
• Are incarcerated or work in a prison
• Had an organ transplant or blood transfusion before the mid-1980s

Hepatitis B may be acute or chronic. Fatigue, loss of appetite, and malaise often develop first. Some may also experience right upper quadrant (RUQ) pain due to liver inflammation, with a small percentage of people also developing fevers, joint pain, or red, itchy hives called wheals.

For people with chronic hepatitis B, these symptoms might progress due to the presence of cirrhosis (permanent scarring and damage to the liver), which results in poor liver function. This can result in additional hepatitis symptoms such as:

• Ascites (fluid buildup in the abdomen)
• Bleeding in the digestive tract due to esophageal varices (enlarged veins in the esophagus, which can lead to excessive bleeding)
• Coagulopathy (tendency to bleed)
• Hepatic encephalopathy, which causes deterioration of brain function when the liver can’t remove toxins from the blood
• Hepatomegaly (enlarged liver)
• Jaundice (along with pale-colored stools and dark-colored urine)
• Redness of the palms
• Spider angiomas (small, spiderlike bloods vessels that can be seen just beneath the surface of the skin)
• Splenomegaly (enlarged spleen)

Hepatitis C

HCV causes hepatitis C. HCV is a blood-borne virus, which means it’s spread from person to person through infected blood.

Hepatitis C is one of the most common types of hepatitis in the U.S. and worldwide. Common modes of transmission for HCV include:

• Sharing needles or other equipment used to prepare and inject drugs
• Reusing syringes, needles, and medical equipment in healthcare settings, especially equipment that hasn’t been properly sterilized
• Transfusing unscreened blood and blood products

HCV may also be passed via perinatal transmission or exposure to infected blood during unprotected sex, although this occurs less often. Those at higher risk for hepatitis C include people who:

• Share needles and other equipment used to prepare and inject drugs
• Had a blood transfusion or organ transplant prior to July 1992 (before blood screening became standard practice)
• Received blood clotting factor as treatment for hemophilia (a blood-clotting disorder) prior to 1987
• Are on long-term dialysis
• Experience a needlestick injury or come into contact with blood or infected needles at work
• Have had a tattoo or body piercing from someone who doesn’t properly disinfect and sterilize their equipment
• Are infected with HIV
• Have sex with a person infected with HCV (with rates being higher among men who have sex with men)
• Are incarcerated or work in a prison
• Are born to a mother with hepatitis C

Hepatitis C can be acute or chronic, although many people don’t experience symptoms during the acute phase. If present, acute symptoms may take weeks to months to appear, some of the most common being dark urine, fatigue, jaundice, joint pain, and muscle weakness. Chronic symptoms of hepatitis C are similar to those that occur with chronic hepatitis B.

Hepatitis D

HDV causes hepatitis D (also called hepatitis delta). It rarely occurs in the U.S, and the only people who get infected with HDV are those infected with HBV. That’s because HDV is an incomplete virus that needs help from HBV to replicate.

It may occur as a coinfection with acute hepatitis B, meaning both HDV and HBV infect the body at the same time. It can also occur as a superinfection with chronic hepatitis B, meaning you already have chronic hepatitis B when you’re infected with HDV.

The symptoms of hepatitis D are similar to those experienced with hepatitis B, but more severe because it occurs as a coinfection or superinfection. People who have a superinfection also tend to experience faster progression to cirrhosis than people with chronic hepatitis B infection alone.

In fact, cirrhosis may develop almost a decade earlier in people who develop this superinfection, although how it accelerates liver damage is unclear. Coinfection and superinfection can also result in fulminant hepatitis (acute liver failure that comes on and progresses quickly).

Transmission of HDV occurs much in the same way as HBV infection, although perinatal transmission occurs much less often. Risk of coinfection is higher among people who:

• Live in endemic areas (such as Mongolia, the Republic of Moldova, and countries in western and central Africa)
• Share needles and other equipment used to prepare and inject drugs
• Have HCV or HIV infection
• Receive dialysis
• Engage in unprotected sex with an infected person, particularly among commercial sex workers and men who have sex with men

Hepatitis E

HEV causes hepatitis E, which is mainly spread through the fecal-oral route. Although HEV infection occurs worldwide, it occurs more often in low and middle-income countries with limited access to clean water and proper sanitation, hygiene, and healthcare services.

HEV is most often spread by:

• Drinking water that contains feces of people infected with the virus. This occurs more often in developing countries such as parts of Africa, Asia, Central America, and the Middle East.
• Eating raw or undercooked pork, shellfish, or wild game such as deer, venison, or wild boar meat.

People infected with HEV may not experience any symptoms, although typical symptoms of hepatitis (such as abdominal pain, fatigue, jaundice, and loss of appetite) may occur. In rare cases, hepatitis E can cause severe symptoms, which may progress to fulminant hepatitis and sometimes death, particularly in pregnant people.

Other types of viral hepatitis

Little is known about hepatitis G, the most recently discovered type of viral hepatitis. It’s most often transmitted through infected blood and blood products, particularly in people who inject drugs (PWID), have a blood clotting disorder such as hemophilia, or who have kidney failure and use dialysis treatments to filter wastes, salts, and fluids from their blood—a function ordinarily performed by healthy kidneys.

Hepatitis G most often occurs alongside chronic hepatitis B or C, but research hasn’t determined whether this virus type can cause hepatitis on its own. Moreover, it isn’t clear whether the hepatitis G virus causes disease in humans at all, as infection doesn’t usually produce symptoms.

Other viruses can also cause hepatitis, although they don’t mainly target the liver and occur less often than the five main types of viral hepatitis. These include herpes viruses such as:

• Cytomegalovirus, which can also cause diseases such as infectious mononucleosis and serious symptoms that can affect the brain, esophagus, eyes, intestines, liver, lungs, and spleen. (Mononucleosis is also known as “mono” or the “kissing disease.”)
• Epstein-Barr virus (also called human herpesvirus 4), which is the main cause of mono and may play a role in the development of other diseases such as multiple sclerosis and blood cancers such as Hodgkin’s lymphoma and non-Hodgkin's lymphoma
• Herpes simplex virus, which can also cause oral or genital herpes
• Varicella-zoster virus (VZV), which also causes chickenpox and shingles (if a person is reinfected with VZV)

Alcohol-induced hepatitis

Drinking alcohol can lead to alcohol-induced hepatitis (formerly called alcoholic hepatitis). It tends to occur in people who drink alcohol heavily for many years.

Over time, drinking excess amounts of alcohol can overload the liver with fats and toxins to process. Liver inflammation occurs when the organ can no longer filter these properly due to damage.

For people who are more sensitive to the effects of alcohol, even moderate use of the substance can induce this form of hepatitis. There’s no safe amount of alcohol when it comes to developing alcohol-induced hepatitis, as people have developed the condition and associated complications such as cirrhosis from drinking small amounts of alcohol.

In addition to drinking alcohol, risk factors for alcohol-induced hepatitis include:

• Having a high body mass index (BMI)
• Being assigned female at birth (AFAB)
• Having the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene mutation

Jaundice is the most common symptom of alcohol-induced hepatitis, although the disease can also result in other symptoms typical of hepatitis such as abdominal pain, fatigue, low-grade fever, loss of appetite, and nausea and/or vomiting. More severe symptoms (associated with complications such as ascites, hepatic encephalopathy, thrombocytopenia, esophageal varices, and kidney and liver failure) may also develop as the disease progresses. (Thrombocytopenia causes levels of blood-clotting cells called platelets, also known as thrombocytes, to drop too low.)

It’s also common for people with alcohol-induced hepatitis to be malnourished. Drinking excess amounts of alcohol tends to decrease people’s appetite, and most of the calories consumed by people who are heavy drinkers often comes from alcohol.

Toxic hepatitis (liver toxicity)

Toxic hepatitis occurs when your body reacts to a substance that can harm the liver (called a toxin) after being exposed to it. This reaction often depends on the dose that's taken of the substance, with the condition being more likely to occur with high doses or prolonged use.

With some substances, it’s harder to predict which doses are more likely to cause this form of hepatitis. In some cases, the dose information or component of the substance that’s causing liver inflammation isn’t known.

Liver toxicity may occur by touching, breathing in, or ingesting the toxin. With acute toxic hepatitis, signs and symptoms of hepatitis may develop immediately or shortly after being exposed to the toxin. With chronic toxic hepatitis, it may take weeks to months following exposure to the toxin for signs and symptoms to manifest.

Alcohol-induced hepatitis is a form of toxic hepatitis, although many other substances can also raise the risk for this condition. Information on more than 1000 medications and herbal compounds known to cause liver toxicity can be found on LiverTox, a searchable database maintained by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Examples include but aren’t limited to:

Herbs and supplements: Examples include aloe vera, anabolic steroids, black cohosh, cascara, chaparral, comfrey, ephedra, germander, green tea extract, kava, mistletoe, and valerian (in rare cases and usually when combined with other herbs such as black cohosh or skullcap).

Industrial chemicals: Examples include the dry cleaning solvent carbon tetrachloride, herbicide paraquat, group of industrial chemicals called polychlorinated biphenyls (PCBs), and a substance used to make plastics called vinyl chloride.

Over-the-counter (OTC) pain medicines: Examples include acetaminophen, ibuprofen, and naproxen, with damage to the liver more likely to occur when any one of these are combined with alcohol or taken frequently.

Prescription medicines: Examples include:

• Statins to treat high cholesterol
• Amiodarone to treat arrhythmias (abnormal heart rhythms)
• Amoxicillin-clavulanate, ciprofloxacin, isoniazid, and sulfamethoxazole-trimethoprim to treat bacterial infections
• Antineoplastic (chemotherapy) drugs used to treat cancer such as alpha inhibitors, tyrosine kinase inhibitors, tumor necrosis factor inhibitors, and methotrexate (also used to treat rheumatoid arthritis)
• Azathioprine to prevent kidney transplant rejection and treat inflammatory conditions such as rheumatoid arthritis
• Ketoconazole to treat fungal or yeast infections
• Valproate and phenytoin to treat seizures

Nicotinic acid (also called niacin or vitamin B3) may be prescribed by your HCP to help reduce low density lipoprotein (LDL or “bad” cholesterol) and raise high density lipoprotein (HDL or “good” cholesterol). Niacin can cause serious liver toxicity, but this is more likely to occur with high doses above 3,000 milligrams (mg) per day.

Doses above 500 mg per day may also raise liver enzymes, such as aspartate transaminase (AST), temporarily. These enzymes are released into the bloodstream when liver inflammation or damage occurs.

Autoimmune hepatitis

Liver inflammation caused by autoimmune hepatitis (AIH) occurs when the immune system mistakenly perceives the body’s liver cells as a threat, sending autoantibodies (immune system proteins that attack the body’s own organs, tissues, and cells) to eliminate them. The two types of AIH include:

Type 1 AIH: Also called classic AIH, type 1 can affect anyone. It accounts for about 80 percent of diagnosed cases of AIH. With this type, anti-smooth muscle antibodies (ASMA) attack smooth muscles cells in the liver. Some refer to type 1 as lupoid hepatitis, as its symptoms may parallel those experienced with the inflammatory autoimmune disease systemic lupus erythematosus. An ASMA blood test can help confirm or rule out type 1 AIH.

Type 2 AIH: Although this type occurs less often, it tends to follow a more severe course. It usually develops earlier in life (often during childhood) and progresses faster than type 1 AIH. Two types of autoantibodies may be involved. Anti-liver-kidney microsome type 1 (anti-LKM-1) antibodies target a protein found in liver cells called cytochrome P450-2D6 (CYP2D6), whereas anti-liver cytosol type 1 (anti-LC1) antibodies are autoantibodies specific to type 2 AIH.

The exact cause of AIH remains unknown, although it’s thought that exposure to certain drugs and environmental agents or infection with a hepatitis virus or the Epstein-Barr virus may trigger the autoimmune response.

For instance, the autoantibodies involved with AIH tend to be present in people with chronic HCV infection. Certain drugs (such as adalimumab, infliximab, methyldopa, minocycline, and nitrofurantoin) can also trigger AIH. In drug-induced cases, hepatitis symptoms improve once the person stops using the drug tied to the autoimmune response.

Symptoms may not be present early in the course of the disease. But as it progresses, common symptoms of hepatitis may develop such as abdominal pain, fatigue, jaundice, joint pain, and malaise.

Neonatal hepatitis

Neonatal hepatitis describes liver inflammation that occurs during early infancy, often within the first two months of being born. In around 20 percent of these cases, infants who develop this condition are infected with a virus that causes liver inflammation while in utero or shortly after being born.

These viruses may include HAV, HBV, HBC, cytomegalovirus, or rubella (also called German or three-day measles). Although no particular pathogen (disease-causing organism such as a virus or bacteria) can be identified in about 80 percent of neonatal hepatitis cases, many experts suspect another virus is the likely cause.

The condition causes jaundice to develop by one to two months of age. Liver inflammation can impede the flow of bile through the bile ducts. (Bile is a digestive fluid made and released by the liver and stored in the gall bladder. The bile ducts are the tubes that connect these two organs to the small intestine.)

Because bile aids in the digestion of fats and absorption of vitamins A, D, E, and K, normal growth and the ability to gain weight may be affected in infants with neonatal hepatitis. An enlarged liver (hepatomegaly) and spleen (splenomegaly) may also develop.

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Viral forms of hepatitis typically progress through four stages (also called phases):

• Phase 1 (viral replication): During this phase, lab results are positive for hepatitis but symptoms aren’t usually present.
• Phase 2 (prodromal): Hepatitis symptoms (such as fatigue, loss of appetite, malaise, nausea, vomiting, itchy skin, and joint pain) may start to appear. In many cases, the condition is misdiagnosed as gastroenteritis (stomach flu) or another type of viral infection.
• Phase 3 (icteric): Hepatomegaly (enlarged liver) may occur during this phase, which may cause abdominal pain in the right upper quadrant (RUQ) and jaundice along with pale-colored stools and dark urine.
• Phase 4 (convalescent): Hepatitis symptoms begin improving and liver function tests (LFTs) show liver enzymes returning to normal levels. Enzymes such as alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transferase (GGT) are released into the bloodstream by damaged or inflamed liver cells.

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After discussing your symptoms, personal and family health history, and any medications, herbs, supplements, or essential oils you may currently use, your healthcare provider (HCP) will conduct a physical exam. This includes looking at your skin and eyes for signs of jaundice, as well as feeling your abdomen to assess whether your liver feels swollen or tender.

If your HCP suspects hepatitis based on your discussion and the results of your physical exam, they may order one or more of the following tests:

Blood tests for hepatitis

These might include:

Liver function tests (LFTs)

Also called a liver panel, LFTs are used to look for markers of disease caused by hepatitis. These might include looking for elevated levels of liver enzymes (such as ALP, ALT, AST, and GGT) and bilirubin (a yellowish byproduct made when red blood cells break down).

Antibody tests

Your HCP may test for certain immunoglobulin (Ig) antibodies produced by the immune system when viral hepatitis is present. This might include looking for IgM antibodies (which develop when an infection first occurs) and IgG antibodies (which develop when the infection starts to clear, thereby providing future immunity against the virus).

Polymerase chain reaction (PCR) test

A PCR blood test can determine whether you have hepatitis C and what your viral load is. It can also determine which hepatitis C strain you have by testing genetic components of HCV such as ribonucleic acid (RNA) that are found in the blood. As such, the test is sometimes called an RNA test.

Imaging tests for hepatitis

Testing may also include:

Abdominal ultrasound

This test uses high-frequency sound waves to create images of structures inside the abdomen. It can detect damage, inflammation, and scarring within the liver (which may indicate cirrhosis), as well as fluid buildup in the abdomen (ascites).

Abdominal CT or MRI scan

Your HCP may want to take a closer look at your liver, if you have a family history of liver cancer among closely related blood relatives (such as a parent or sibling) or if they suspect you might have cancer or other liver issues based on the results of your blood tests or ultrasound. In these cases, they may recommend a computer tomography (CT) or magnetic resonance imaging (MRI) scan of the abdomen.

Specialized imaging tests

A common complication of hepatitis is fibrosis (liver stiffness), which is caused by liver scarring. Specialized imaging tests—such as a transient elastography (TE), magnetic resonance elastography (MRE), or acoustic radiation force impulse (ARFI) scan—apply sound waves to the abdomen to assess the degree of fibrosis.

Liver biopsy

In rare cases, a liver biopsy may be needed to provide greater detail than what’s seen on imaging tests. This involves removing a sample of liver tissue and examining it under a microscope to view the full extent and cause of liver damage.

In addition to fibrosis, a biopsy can detect other issues that may be associated with liver issues such as:

• Fatty liver (excess fat in the liver)
• Chronic liver inflammation
• Hemochromatosis (iron overload)
• Metabolic liver diseases such as Wilson disease (which causes copper to build up)
• Liver cancer

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The treatment for hepatitis can vary. Your HCP will work with you to develop an effective treatment plan based on the type you have, other conditions you have, medications you take, and your treatment preferences.

Hepatitis A treatment

Hepatitis A is an acute (short-term) infection, which usually clears on its own. Supportive therapies are therefore usually recommended. These often include resting and staying hydrated with healthy fluids such as water and nourishing, water-rich foods such as melons and berries.

Hepatitis B treatment

Like HAV infection, treating acute hepatitis B usually involves supportive care. Severe cases may be treated with a lamivudine. This medication, which is also prescribed to treat HIV, belongs to a class of drugs called nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs work by keeping the virus from replicating.

Chronic hepatitis may be treated with antiviral medications. These include oral antivirals, such as entecavir or tenofovir, taken by mouth.

Pegylated interferon (PEG-IFN) alfa-2a is a weekly antiviral shot your HCP can give you for treatment of chronic HBV infection. It belongs to a drug class called interferons, which mimic the effects of natural interferons (immune-system proteins) produced by the body.

Hepatitis C treatment

For some people, detection of HCV infection may not occur until the disease has become chronic. Nevertheless, hepatitis C treatment usually involves using one or more types of direct-acting antiviral (DAA) medications. These block the action of certain enzymes that facilitate HCV replication, which helps lower the body’s viral load.

Oral DAAs used to treat hepatitis C include:

• Elbasvir
• Glecaprevir
• Grazoprevir
• Ledipasvir
• Ombitasvir/paritaprevir/ritonavir (combination formula)
• Pibrentasvir
• Sofosbuvir
• Velpatasvir
• Voxilepravir

An older hepatitis medicine called ribavirin or PEG-IFN alfa-2a or PEG-IFN alfa-2b may also be added to the treatment plan.

Hepatitis D treatment

There’s no specific treatment for acute hepatitis D. Chronic HDV infection is treated with an interferon such as PEG-IFN alfa-2a. Treatment for hepatitis B may also be needed, since HDV infection occurs alongside HBV infection.

Hepatitis E treatment

Supportive therapies are generally recommended for acute hepatitis E. These include resting, staying well-hydrated, and eating nourishing foods that promote recovery. Your HCP may also recommend ribavirin or PEG-IFN alfa-2a for chronic hepatitis.

Treatment for other viruses that cause hepatitis

There’s no recommended treatment for hepatitis G, particularly since HGV doesn’t usually produce symptoms and it isn’t clear whether it causes disease in humans. Other viral infections that cause hepatitis may be treated with antiviral medicines, depending on which virus is involved.

Alcohol-induced hepatitis treatment

Quitting drinking is essential to treating alcohol-induced hepatitis. If needed, your HCP can help you with an effective treatment plan to quit drinking alcohol and achieve and maintain sobriety.

These might involve a combination of interventions, including medications to treat alcohol-use disorder (such as acamprosate, disulfiram, and naltrexone), participating in an outpatient or residential treatment program, individual counseling such as talk therapy with a licensed mental health provider, and/or joining a support group such as Alcoholics Anonymous (AA).

Other treatments for alcohol-induced hepatitis may include:

Nutrition therapy for malnutrition: This might involve working with a registered dietitian nutritionist (RDN) to create an eating plan to help correct nutritional deficiencies and increase your intake of calories. Your HCP may also prescribe nutritional supplements to help your body recover, as well as an appetite stimulant to boost your appetite.

If you’re severely malnourished, you may be admitted to the hospital for further care. This may include enteral nutrition (tube feeding) if you can’t consume or absorb enough nutrients to meet your body’s nutritional needs.

Medicine to decrease liver inflammation: In severe cases of alcohol-induced hepatitis, a short course of corticosteroids (also called glucocorticoids or steroids) may be prescribed to help decrease liver inflammation and promote liver cell regeneration. If you’re unable to take corticosteroids, your HCP may recommend another medication to reduce inflammation called pentoxifylline.

Liver transplant for end-stage liver disease: When the liver is severely damaged due to chronic liver disease or acute liver failure (ALF), a liver transplant may be an option. To be a candidate for a liver transplant, you have to abstain from alcohol for at least six months.

The procedure often involves transplanting a healthy liver from a deceased donor. With a living-donor transplant, a portion of the donor’s liver is used to replace the recipient’s diseased liver. Both the donor’s remaining liver and the recipient’s newly transplanted liver will regenerate (or grow back to full size) soon after the surgery.

Toxic hepatitis treatment

After your HCP determines which toxin is causing liver inflammation, you’ll work on stopping exposure to the offending agent. If the toxic agent is a medication or supplement you take, your HCP will likely recommend that you discontinue using it. In many cases, this helps reduce the signs and symptoms of toxic hepatitis.

Other treatments for toxic hepatitis might involve:

Supportive therapies: Certain symptoms of toxic hepatitis that persist or are severe may need to be treated in a hospital setting with intravenous (IV) fluids and medications. This includes treatment for dehydration or persistent or severe nausea and vomiting. Your HCP will also continue monitoring your liver health.

Medication to treat drug-induced liver injury (DILI): An acetaminophen overdose may be treated with a medication called N-acetyl-cysteine (NAC). Valproic acid overdose may be treated with L-carnitine.

Emergency treatment: If you’re experiencing signs and symptoms of toxic hepatitis or you think you’ve taken an overdose of a drug, it’s important to get treated at your local hospital emergency department (ED) right away. Prompt treatment in the ED is usually needed to remove the toxic agent from the body and/or lessen its toxic effect.

Liver transplant: A liver transplant may be needed if the toxin severely impairs liver function causing acute liver failure (ALF), especially since ALF carries a high risk of death.

Autoimmune hepatitis treatment

Treatment for autoimmune hepatitis usually starts with a high dose of a corticosteroid such as prednisone or budesonide. This helps reduce inflammation and suppress the body’s autoimmune response.

The corticosteroid may be used alone or in combination with the immunosuppressant drug azathioprine. Once the results of liver function tests (LFTs) return to normal ranges, corticosteroid dosing is tapered off and azathioprine alone is used for maintenance therapy.

Azathioprine therapy is also discontinued once LFTs remain within the normal range for at least a year. You may need to continue taking it on and off for life, depending on whether you’re in remission from autoimmune hepatitis or experience a relapse.

Neonatal hepatitis treatment

There isn’t a specific treatment for neonatal hepatitis. The infant is usually given a formula that contains fats that are easier to digest along with vitamin supplements.

The antiseizure drug phenobarbital may be prescribed to stimulate the liver to excrete more bile. Neonatal hepatitis caused by HAV often gets better within six months. In contrast, infants with HBV or HCV infection often experience chronic liver disease. If their condition progresses to cirrhosis, a liver transplant will eventually be needed.

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Although acute hepatitis usually resolves on its own, severe cases may cause fulminant liver failure. Chronic hepatitis can result in fibrosis when the liver becomes scarred.

When barraged by constant inflammation, the liver forms scar tissue in an effort to heal itself. But this scar tissue damages the liver and affects its ability to function properly. As scarring becomes more widespread, fibrosis can progress to cirrhosis. Liver failure may ensue.

Other complications associated with the various types of hepatitis or complications, such as fibrosis and cirrhosis, may include:

Ascites: Excess fluid may build up in the abdomen, which can cause issues such as abdominal swelling, pain, and fullness. This can lead to issues such as loss of appetite, indigestion, and difficulty breathing comfortably.

Coagulopathy: This condition affects the blood’s ability to coagulate (that is, to form clots).

Cryoglobulinemia: This condition is a form of vasculitis (inflammation of the blood vessels, which restricts blood flow to organs and tissues). It causes abnormal proteins in the blood called cryoglobulins to form, thicken, and clump together when the temperature of the body falls below 98.6 degrees Fahrenheit. This can damage the skin, muscles, nerves, and organs, especially the kidneys and more rarely the heart, brain, and gastrointestinal tract.

Esophageal varices: These are dilated (expanded) blood vessels that develop most often in the stomach and esophagus due to high blood pressure in the portal vein (the large vein that delivers blood from the intestine to the liver) and the blood vessels that branch from it.

Liver scarring can block blood flow, causing these blood vessels to expand as pressures in them rise. Severe bleeding (hemorrhage) can occur when pressures rise too high, as these blood vessels aren’t able to expand this much.

Fulminant hepatic failure (FHF): This is acute liver failure (ALF) that occurs in people with no prior history of liver disease, resulting in rapid deterioration of liver function. Roughly 1 percent of people with viral hepatitis develop FHF, a condition that carries an 80 percent mortality rate.

Glomerulonephritis: This condition inflames and damages the tiny filters inside the kidneys called glomeruli, affecting the organ’s ability to remove excess fluid and waste.

Hepatic encephalopathy: This is a brain disorder that occurs when the liver is unable to filter toxins from the blood, resulting in changes to or loss of brain function.

Hepatic (liver) necrosis: This describes the death of liver cells (called hepatocytes) because of liver damage or disease.

Hepatocellular carcinoma (HCC): This is the most common type of primary liver cancer, which is cancer that starts in the liver. HCC occurs most often in people with chronic liver diseases such as cirrhosis caused by hepatitis B or C infection.

Hepatorenal syndrome (HRS): This life-threatening condition impairs kidney function in people with advanced liver disease.

Portal hypertension: This is high blood pressure in the portal vein and its branches.

Severe thrombocytopenia: This condition causes platelet (thrombocyte) levels to drop too low. Platelets are blood cells that form blood clots to help stop bleeding.

Spontaneous bacterial peritonitis (SBP): This is an acute infection of the excess fluid that builds up in the abdomen due to ascites. SBP is most often a complication of advanced liver or kidney disease.

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It’s important to see your HCP as soon as possible if you suspect your symptoms may be due to hepatitis or if they persist or are severe. In some cases, your HCP may recommend you call 911 or go to the nearest hospital ED for further evaluation and care.

Be sure to get prompt medical care for severe or persistent hepatitis symptoms such as:

• Abdominal pain and/or discomfort, such as in the right upper quadrant (RUQ) of your abdomen just below your right rib cage
• Chest pain and/or discomfort
• Confusion, disorientation, or coma (loss of consciousness)
• Diarrhea or vomiting for more than 48 hours, which may include bloody stool or vomit
• Edema (swelling) in your abdomen, legs, feet, or ankles
• Extreme fatigue
• Dizziness, lightheadedness, or drowsiness
• Fever that doesn’t respond to measures to bring your body temperature down or persists for more than 48 hours
• Jaundice
• Shortness of breath

What questions should you ask your healthcare provider?

Be sure to ask your HCP any questions you might have. These might include any or all of the following:

• What type of hepatitis do I have? Is it an acute or chronic infection?
• Which hepatitis stage am I in and what’s my prognosis?
• Am I at risk for fibrosis, cirrhosis, or liver cancer?
• Will I need treatment or will my condition improve on its own?
• Which treatments do you recommend and why? What are the risks, side effects, and benefits of each treatment?
• What is my viral load and how can it affect my treatment outcome?
• How long do I need to be on each treatment?
• Do I need to be admitted to the hospital for treatment?
• What precautions do I need to take while receiving treatment?
• How can treatment affect my daily life and/or ability to work or go to school?
• What changes do I need to make in my daily life?
• Are there any measures I can take to prevent a relapse?
• Are there any foods or drinks (in addition to alcohol) that I need to limit or avoid?
• Are there any over-the-counter medications, herbs, supplements, or essential oils I need to avoid?
• How often do I need to follow up with you? How will you monitor whether my hepatitis has progressed?
• Do I need the hepatitis A or B vaccine?
• How can I protect my loved ones from getting hepatitis?

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Taking precautionary measures can lower your risk of getting or spreading hepatitis. These include:

Get hepatitis vaccines

Several hepatitis A and B vaccines have been approved for use in the U.S. The hepatitis A vaccine (either Havrix or Vaqta) is given in two doses for people 12 months of age and older.

Four different vaccines can be used to protect against hepatitis B, including:

• Engerix: Three doses are given to people aged 16 and older.
• Heplisav-B: Two to three doses are given to adults aged 18 and older.
• PreHevbrio: Three doses are given to adults aged 18 and older.
• Recombivax HB: Three doses are given to people of all ages.

Combination vaccines include:

• Pediarix: Three doses are given to infants and children up to 6 years old to prevent hepatitis B, diphtheria, tetanus, acellular pertussis, and polio.
• Twinrix: Three to four doses can be given to adults aged 18 and over to protect against hepatitis A and B.
• Vaxelis: Three doses are given to infants and children up to 6 six years old to prevent hepatitis B, diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b. Hib is different from influenza (also known as the flu), so a flu shot does not protect against Hib.

There’s currently no vaccine for HCV, HDV, HEV, and HGV infections or other hepatitis types. That said, getting the hepatitis B vaccine also offers protection against coinfection with hepatitis D. However, it can’t prevent an HDV superinfection in people with chronic hepatitis B.

Prevent hepatitis A or B after, if exposed to either virus

People exposed to HAV who haven’t received a hepatitis A vaccine can be given one of the following for postexposure prophylaxis, which is a treatment or measure used to help prevent the disease after you have been exposed to the virus:

• One dose of the hepatitis A vaccine may be given to healthy people aged 1 to 40.
• Standard immune globulin may be given to people who have a weakened immune system, have chronic liver disease, or are over the age of 40.

Standard immune globulin (IG) is a preparation that contains various antibodies collected from the plasma (liquid portion of blood) of people with a healthy immune system. As part of the body’s immune system, IGs can help prevent symptoms or reduce the severity of HAV infection. To increase effectiveness, standard IG should be given within 48 hours of exposure.

People exposed to HBV who haven’t received a hepatitis B vaccine can be given hepatitis B immune globulin, which is prepared using antibodies collected from people with high levels of antibodies to HBV. Hepatitis B immune globulin helps prevent symptoms or reduce disease severity, although it may not prevent HBV infection.

Hepatitis B immune globulin may also be given to babies born to mothers with hepatitis B. Unlike the hepatitis A or B vaccine, each dose of immune globulin only provides short-term protection against HAV or HBV infection. For instance, standard IG can protect against HAV virus for up to two months, depending on the dosage given.

Follow safety precautions when traveling

Aim to get fully vaccinated against hepatitis A and B. This is especially true if you plan to travel to areas where either virus is endemic.

It often takes several weeks (or longer) for full immunity to develop after vaccination. Moreover, it may take two months or longer to get all the recommended vaccine doses.

Therefore, it’s important to talk with your HCP well ahead of time about when you need to schedule each dose. This way you can have your doses completed prior to your trip and your body has enough time to produce a sufficient amount of protective antibodies.

If you’re traveling to an endemic area, health experts also advise avoiding food from street vendors or raw or undercooked food, including fish and other seafood. Don’t eat fruits and vegetables, unless you peel and cook them yourself, as these may have been washed with contaminated water.

It’s also best to boil all water you use for drinking or brushing your teeth or treat it with chemical-purifying tablets. Also, ask for drinks without ice as the cubes may contain contaminated water. If you’re unable to boil or purify your water, use bottled water with the seal intact to drink, wash your hands, and brush your teeth.

Practice good hygiene

Maintaining good personal hygiene, including frequent hand washing, can also help keep hepatitis viruses from spreading. If you touch a dirty or contaminated surface, your hands are visibly soiled, or you’re about to eat or drink any food, it’s important to wash your hands properly and thoroughly for at least 20 seconds beforehand with soap and clean water. If you don’t have access to soap and clean water, rub your hands thoroughly for at least 20 seconds with a hand sanitizer that contains at least 60 percent alcohol.

Other ways to help prevent the spread of hepatitis include the following:

• Avoid handling food for others if you have hepatitis until your HCP has let you know you’re no longer shedding the virus.
• Avoid sharing personal items, such as toothbrushes or razors, as any amount of blood, saliva, semen, or vaginal fluids from these items may contain the virus.
• Don’t share needles or other products used to prepare or inject drugs.
• Don’t have unprotected sex with people who have hepatitis.

Prevent other types of hepatitis

You can help avoid the spread of other types of hepatitis by following these practices:

Get screened during pregnancy

All people who are pregnant must be screened for hepatitis B and HIV. In some cases, these infections must be actively treated during pregnancy, depending on the person’s viral load. It’s recommended that all newborns who test positive for HBV infection be given a hepatitis B vaccine dose within 12 hours of birth to keep the virus from spreading.

Test for autoimmune disease

Testing for other autoimmune diseases is also recommended for people with autoimmune hepatitis, along with early referral to a medical doctor such as a hepatologist who specializes in diagnosing and treating diseases that affect the liver, bile ducts, gallbladder, and pancreas.

Take caution with chemicals and use medicines carefully

This includes using proper protective gear such as gloves, goggles, gowns, and face masks or shields. Also, use OTC medicines (including acetaminophen), herbs, supplements, and essential oils as indicated on the product label, which includes not exceeding the recommended dose. Before using any of these for the first time, it’s best to talk with your HCP about their risks, side effects, and benefits along with conducting your own research on the product.

The same goes for your prescription medicines. Be sure to take them as prescribed by your HCP. If you experience any untoward side effects, be sure to let your HCP know right away as they may be able to prescribe you a different medication. Lastly, it’s important to avoid alcohol if you’re at risk for or have already been diagnosed with alcohol-induced hepatitis.

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The outlook depends on the type and/or cause of hepatitis.

Outlook for viral hepatitis

Hepatitis A is typically an acute infection that gets better on its own. Moreover, people infected with HAV develop lifelong immunity from future hepatitis A infection. Mortality rates are low and complications and relapse rarely occur, although young children, older adults, and those who have compromised immune systems are at higher risk for complications compared to otherwise healthy adults.

People with acute hepatitis B are at risk of developing chronic hepatitis B, as well as hepatocellular carcinoma. Around 0.5 to 1 percent of people with hepatitis B develop fulminant hepatic failure, which carries an 80 percent mortality rate.

Around 50 to 60 percent of people with acute HCV infection go on to develop chronic hepatitis C, raising the risk for complications such as cirrhosis and hepatocellular carcinoma. The chronic form of the disease is also one of the main reasons for liver transplantation.

Chronic hepatitis D and B occur more often in people also infected with acute HBV and HDV, with many progressing to cirrhosis and end-stage liver disease. Coinfection with HBV and HCV commonly occurs, although disease severity doesn’t increase.

Acute hepatitis E also resolves on its own. But for reasons that aren’t clear, the mortality rate for pregnant people is around 15 to 25 percent. It’s rare for acute hepatitis G infection to become chronic or progress to fulminant hepatic failure, and it isn’t clear whether the virus alone causes disease in humans.

Outlook for alcohol-induced hepatitis

Liver function tends to improve over months to years in people who abstain from alcohol, whereas people who continue drinking tend to get worse, eventually developing cirrhosis. The mortality rate for people who experience coagulopathy, hepatic encephalopathy, and jaundice in addition to alcohol-induced hepatitis is about 40 percent.

Outlook for toxic hepatitis

Around 90 percent of people recover from toxic hepatitis once the toxin in question has been identified and avoided or removed from contact.

Outlook for autoimmune hepatitis

The outlook for autoimmune hepatitis depends on the severity of liver inflammation. The mortality rate is higher and the prognosis is worse among people who experience severe symptoms and show signs of extensive liver damage when the disease first develops.

The outlook also tends to be worse for people who relapse often or don’t respond well to treatment. Around 10 percent of people with autoimmune hepatitis need a liver transplant. Around half of all people who don’t get the treatment they need end up dying from the disease within five years.

Around 70 percent of children with this form of hepatitis need treatment as adults. Those with autoimmune hepatitis who develop cirrhosis are less likely to develop hepatocellular carcinoma compared to those who develop cirrhosis from other causes.

Outlook for neonatal hepatitis

Neonatal hepatitis caused by HAV tends to get better on its own within six months. In contrast, infection with HBV or HCV tends to result in chronic liver disease. If the disease progresses to cirrhosis, a transplant will eventually be needed.

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Being diagnosed with hepatitis can be stressful and living with the disease can be life-changing. The stigma that sometimes comes with having the disease can also impact relationships and leave you feeling alone and isolated.

Below are a few tips to help you manage hepatitis more effectively and better cope with the ups and downs of living with the disease.

Ease stress. Find meaningful ways to bring your stress level down. For some, journaling is a way to cope with strong emotions, whereas others prefer to sing their favorite tunes or calm the body and mind with yoga.

Find support. Let people close to you know how you’re feeling and how they might offer support. Be open and honest about your thoughts, feelings, and concerns. You may want to reach out to a spiritual advisor or a licensed mental health provider. Joining a support group may also help you connect with others who know what it feels like to live with hepatitis.

Focus on nutrient-rich foods. Focus on eating nourishing foods rich in fiber such as whole grains, fruits, and vegetables while limiting saturated fats and added sugars. Avoiding alcohol can also support your liver health. You may also want to ask your HCP for a referral to a registered dietitian nutritionist (RDN), who can help you can create an eating plan that aligns with your food preferences and supports your health needs.

Get active. Working out and staying active on a regular basis helps you lose excess body fat, including the extra fat in your liver. Working out can also lift your spirits.

Learn as much as you can about hepatitis. Get in-depth knowledge about the type of hepatitis you have, including how to treat and prevent it from spreading. This can help you and others in your social circle better understand what the disease is and what it isn’t, which can help dispel feelings of fear and uncertainty.

Seek social services. Ask your HCP for a referral to a licensed social worker. They may be able to help you with finding financial resources, counseling services, and other help within your community that can ease the day-to-day burden of living with hepatitis.

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• What’s the Difference Between Hepatitis A, B, and C?
• The Hepatitis C Diet
• Why Early Treatment for Hep C is Important