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Viral Hepatitis
Overview
- What is hepatitis?
The liver is an essential organ in the body and carries out a wide range of functions, including removing poisons from the body, storing energy, and regulating blood clotting.
Hepatitis is inflammation of the liver that may be due to alcohol, viruses, medications, or problems with the immune system.
- What is viral hepatitis?
Viral hepatitis refers to inflammation of the liver due to a viral infection that specifically attacks the liver. These viruses are labeled with the letters A, B, C, D and E. The most common viruses in the United States are A, B and C.
- How is viral hepatitis transmitted?
Both Hepatitis A and Hepatitis E are primarily spread through the fecal-oral route, meaning the virus is ingested when food or water becomes contaminated with stool from an infected person. Hepatitis A can also spread in crowded environments like daycare centers and correctional facilities, through eating raw shellfish from contaminated water, or via certain types of sexual contact. Hepatitis E is uncommon in the United States but is seen more often in parts of Asia and Africa. Keyways people are exposed to Hepatitis E include drinking contaminated water, especially in regions with inadequate sanitation, and through contaminated food such as undercooked meat from infected animals (like pigs or deer), raw or undercooked shellfish from contaminated waters, and fresh produce that has been irrigated with contaminated water or handled by an infected person.
Hepatitis B and Hepatitis C are primarily transmitted through contact with infected blood or other body fluids. In the United States, the most common way Hepatitis C spreads is by sharing needles or other equipment used for injecting drugs. While less common, Hepatitis C can also be transmitted through heterosexual sexual contact, and it's increasingly recognized as a concern among men who have sex with men. Hepatitis B, on the other hand, can spread through sexual contact, sharing needles, or from an infected mother to her baby during childbirth.
Hepatitis D (sometime referred to as Delta virus) only affects people who already have hepatitis B because it needs the hepatitis B virus to survive. It spreads the same way as hepatitis B, through infected blood, sexual contact, or from mother to baby during birth.
- What is acute viral hepatitis? What are its symptoms and consequences?
Acute viral hepatitis refers to inflammation of the liver that lasts for less than six months. This condition can be triggered by any of the hepatitis viruses: A, B, C, D, or E.
Common symptoms often include a low-grade fever, headaches, muscle aches, and a general feeling of tiredness. Patients might also experience loss of appetite, abdominal pain, nausea, vomiting, and diarrhea. One of the most recognizable signs is jaundice, where the skin and the whites of the eyes take on a yellow tint.
Fortunately, most individuals with acute viral hepatitis recover fully without any lasting liver damage. However, a small percentage may develop severe liver failure, which can be life-threatening and might even necessitate a liver transplant. It's particularly important to note that Hepatitis E can be especially dangerous during pregnancy, potentially leading to serious complications.
The progression of these infections can vary significantly. Unlike most other hepatitis viruses, Hepatitis C often doesn't resolve on its own; over 80% of people with acute Hepatitis C go on to develop a long-term condition known as chronic Hepatitis C. For Hepatitis B, most adults recover completely, but infants and young children are at a much higher risk of developing chronic Hepatitis B after infection.
- What is chronic hepatitis? What are its consequences?
Chronic viral hepatitis refers to long-term inflammation of the liver that persists for more than six months, most commonly caused by Hepatitis B or Hepatitis C viruses. If left untreated, this condition can lead to serious health issues over time, including cirrhosis (which is scarring of the liver), liver failure, and even liver cancer. It's important to note, however, that not everyone with chronic hepatitis will develop these severe complications.
Factors like drinking alcohol can worsen the problem, accelerating liver damage. Fortunately, early testing, consistent medical care, and appropriate treatment can significantly help prevent many of these complications. For Hepatitis B, vaccination is the most effective way to prevent infection and its long-term effects. While there isn't a vaccine for Hepatitis C, highly effective treatments are available for those who are infected.
Diagnosis
- How is viral hepatitis diagnosed?
Diagnosing viral hepatitis typically begins with straightforward blood tests. Your doctor will often suggest an imaging study, such as an ultrasound or CT scan of your liver, to check for any signs of scarring or more advanced liver disease. Occasionally, a specialized non-invasive test called an elastography might also be recommended to assess the degree of scarring in your liver. Fortunately, a liver biopsy is rarely necessary these days, as we now have these less invasive tests that can effectively evaluate the severity of your liver disease.
Treatment
- How is viral hepatitis treated?
Acute Viral Hepatitis
Most people with acute viral hepatitis do not need treatment because their bodies clear the infection on their own. Acute Hepatitis C is different. Without treatment, most people will develop chronic Hepatitis C. Treating hepatitis C early gives an excellent chance of curing the infection.
Chronic Hepatitis B
Chronic Hepatitis B is treated with antiviral medicines that slow or stop the virus from multiplying. These medicines help protect the liver and lower the risk of serious liver damage.
Most people take oral antiviral medications, which are safe, effective, and have very few side effects. Some people may also be treated with pegylated interferon, an injectable medication that is used less often. While current treatments control hepatitis B very well, they do not completely remove the virus from the body. Most people will need long-term treatment to keep the virus under control.
Chronic Hepatitis C
Currently, Hepatitis C is effectively treated with oral antiviral medications. These medicines are typically taken by mouth for a period of 8 to 24 weeks and boast a cure rate of over 95% for infections. It's crucial to understand, however, that even after successful treatment and achieving a cure, individuals can still become re-infected if they are exposed to the Hepatitis C virus again. Therefore, even if you've been successfully treated for Hepatitis C, it remains important to continue avoiding situations that could lead to re-exposure to the virus.
- Why is it important to treat chronic hepatitis?
Treating chronic Hepatitis B and C is crucial because it helps prevent cirrhosis, a severe scarring of the liver that can ultimately lead to liver failure or liver cancer. Beyond protecting the individual, treatment also plays a vital role in reducing the risk of spreading the virus to others.
A significant challenge with chronic hepatitis is that it often causes no symptoms, meaning many individuals are unaware they are infected until liver damage has already progressed. This underscores why early testing and timely treatment are so important for preventing serious complications. To address this, it's recommended that all adults in the U.S. be screened for Hepatitis C at least once in their lifetime. Similarly, adults who are at risk for Hepatitis B exposure should also be screened for that virus.
- Are there side effects associated with the medications used to treat chronic hepatitis B and C?
Hepatitis C is treated with oral antiviral medications. Most people experience very few side effects. The most common ones are usually just a headache or feeling tired. It's really important to remember that some of these antivirals can interact with other medicines you might be taking, so your healthcare provider will always need to review all your current medications before you start treatment.
If ribavirin is part of your treatment plan, you might experience side effects like anemia, a skin rash, or shortness of breath. The good news is that your healthcare team can usually help manage these effectively.
For Hepatitis B, treatment is also typically with oral antiviral medications. Most patients tolerate these antivirals without any trouble, but they can sometimes affect your kidney function and bone health, so these will be monitored regularly. An injectable medication called pegylated interferon is available but rarely used because it can cause more significant side effects including flu-like symptoms, anemia, and even depression.
Overall, managing treatment for chronic Hepatitis B or C really requires a healthcare provider who has a lot of experience in caring for people with viral hepatitis.
- Can viral hepatitis be prevented?
Yes. Many cases of viral hepatitis can be prevented through vaccination, good hygiene, and avoiding high risk behaviors such as intravenous drug use and unprotected sex with multiple partners.
Preventing Hepatitis A and E
Hepatitis A and hepatitis E spread through food or water contaminated with stool from an infected person. You can lower your risk by:
- Washing your hands with soap and water before eating and after using the bathroom
- Drinking safe, clean water
- Avoiding food or drinks prepared in unsanitary conditions
- Avoiding raw or undercooked shellfish
If you are traveling to areas where hepatitis A is common, drink bottled water, avoid ice made from tap water, and avoid food from street vendors. A hepatitis A vaccine is available and is the best way to prevent hepatitis A. It is given as two doses, usually 6 months apart. The vaccine is recommended for travelers to countries where hepatitis A is common and for people at higher risk, including:
- Men who have sex with men
- People who inject drugs
- People with chronic liver disease
- People with certain bleeding disorders, such as hemophilia
In some situations, such as after recent exposure to hepatitis A or before short-term travel, immune globulin (IG) may be recommended for short-term protection.
Preventing Hepatitis B
The best way to prevent hepatitis B is vaccination. The hepatitis B vaccine is safe, effective, and provides long-lasting protection. The vaccine is recommended for:
- All infants and children
- People who inject drugs
- Men who have sex with men
- People with multiple sexual partners or other risk factors for infection
- Healthcare workers and others who may be exposed to blood
Babies born to mothers with hepatitis B should receive the first dose of the hepatitis B vaccine and immune globulin (IG) within 12 hours of birth. This greatly reduces the risk of infection. If the mother has high levels of hepatitis B virus during pregnancy, she may also receive antiviral medication to further lower the chance of passing the virus to her baby.
A combined hepatitis A and hepatitis B vaccine is available for adults who need protection against both viruses.
Preventing Hepatitis C
There is no vaccine for hepatitis C. The best ways to prevent hepatitis C are to:
- Never share needles or other drug equipment
- Avoid contact with another person's blood
- Practice safe sex
- Make sure tattoos and piercings are done using sterile equipment.
Preventing Hepatitis D
There is no vaccine for hepatitis D. However, hepatitis D can only infect people who already have hepatitis B. Getting the hepatitis B vaccine also protects against hepatitis D.
- Is it true that herbal medicines can cure viral hepatitis?
There is no scientific evidence to suggest that herbal medicines can cure viral hepatitis or prevent long-term liver damage. Before you consider taking any prescription medications, over-the-counter drugs, vitamins, or herbal supplements, it's always best to have a conversation with your healthcare provider. This is crucial because some herbal products can interact negatively with your existing medications or even cause serious damage to your liver. Generally speaking, it's advisable to avoid herbal supplements due to the potential risk of significant liver injury associated with many of them.
Author(s) and Publication Date(s)
George G. Abdelsayed, MD, FACP, FACG, and Daniel Stupak, MD, Bridgeport Hospital, Bridgeport, CT – Published November 2010.
George G. Abdelsayed, MD, FACG and Moiz Ahmed, MD, Staten Island University Hospital-Northwell Health, NY, Bridgeport Hospital, Bridgeport, CT – Updated June 2016.
Sharifeh Almasaid, MD, MPH, Henry Ford Hospital, Detroit, MI and Nader A. Dbouk, MD, Emory Transplant Center, Atlanta, GA – Updated July 2026.