Viral Hepatitis

Hepatitis is a serious disorder in which liver cells become inflamed. The inflammation is most occurs because of a virus. It can also be caused by an overactive immune system, and from drugs, alcoholism, chemicals, and environmental toxins. Viral hepatitis usually appears as type A, B, or C.

Type A, the most common form of viral hepatitis, often affects school-aged children. The disease is transmitted by contaminated food or water, or contact with a person ill with hepatitis A. The hepatitis A virus is shed in the stools of an infected person during the incubation period of 15 to 45 days before symptoms occur and during the first week that the person feels sick. Blood and other body fluids may also carry the infection. The virus does not stay in the body after the infection has resolved, and, unlike hepatitis types B and C, there is no "carrier" state (a person who spreads the disease to others but does not become ill).

Hepatitis types B and C affect people of all ages. Most people who become infected with hepatitis B get rid of the virus within 6 months. This type of short infection is known as an "acute" case of hepatits B. Approximately 10% of people infected with the hepatitis B virus develop a chronic, life-long infection. People with chronic infection may or may not have symptoms. Those who do not develop symptoms are referred to as carriers. Having chronic hepatitis B increases your chance of permanent liver damage, including cirrhosis (scarring of the liver) and liver cancer.

Signs and Symptoms

Acute Hepatitis Chronic hepatitis may not be preceded by an acute phase or the acute symptoms may be quite subtle and go unnoticed. In fact, some people with hepatitis C only feel mild ongoing fatigue and, perhaps, whole body itching. The virus is then found by a blood test.


Hepatitis A is usually transmitted from feces on unwashed hands (putting dirty hands into the mouth) and by ingesting contaminated food and water (for example, seafood from sewage contaminated water). It can also be transmitted through close contact with someone who has the virus.

Hepatitis B and C are transmitted via blood; therefore, blood transfusion, intravenous (IV) drug use with contaminated needles, and sexual activity are all ways that people have contracted either of these viruses. In as many as 40% of the cases of hepatitis C, the specific cause of transmission is unknown. Blood and blood products that are used for transmission can now be tested for both hepatitis B and C. The latter test has been available since 1992.

Risk Factors

Hepatitis A Hepatitis B Hepatitis C


First, your doctor will ask you a host of questions to assess your risk for the different types of viral hepatitis. Questions will inlude whether you: Next, your doctor will examine your abomen carefully including palpating your liver and spleen to see if either is enlarged or tender. Then, a blood test will be performed to assess your liver function and test for antibodies against the specific hepatitis viruses. Your doctor will likely request a urine test as well. For chronic hepatitis, a liver biopsy may be required, which must be done under general anesthesia. A liver biopsy is particularly important if you have chronic hepatitis C because this test assesses the degree of liver damage, which can occur even if you have no symptoms.

Preventive Care

Hepatitis A
Transmission of the virus can be reduced by faithfully following these practices, particularly in child daycare facilities and other institutions involving close contact with people: Hepatitis B and C
Preventive measures are the same for both hepatitis B and C. Immunization

Hepatitis A
Candidates for the hepatitis A vaccine include: Hepatitis B
There are several inactivated vaccines available for hepatitis B. Immunization provides the only definitive protection against hepatitis B. The hepatitis B vaccine is one of the recommended childhood immunizations, and is now part of routine pediatric care in the United States. Adults who are at higher risk, should also be vaccinated: Hepatitis C
There is no vaccine for hepatitis C, but immunoglobulin helps protect against it after blood transfusions. Periodic doses in sexual partners of an infected person may also help to give protection.

Treatment Approach

Acute Hepatitis
The goals for treating acute viral hepatitis include: There are no medications to treat acute hepatitis, although your doctor may recommend drugs that alleviate some of the symptoms. Most cases of acute hepatitis are mild and do not even require hospitalization. Only people who are at high risk for complications, such as pregnant women, the elderly, people with serious underlying medical conditions, or those who become significantly dehydrated from excessive nausea and vomiting need to be hospitalized. The very rare cases of acute hepatitis that lead to liver failure (called fluminant acute hepatitis) not only require hospitalization, but also need liver transplantation. Chronic Hepatitis
The goals for treatment of chronic viral hepatitis include: There are several medications from which your doctor will choose to help achieve these goals.

Because the conventional medications used to treat chronic hepatitis have a lot of unpleasant side effects, many people with this condition turn to alternative medical therapies instead. Despite the popularity of herbs, particularly milk thistle (Silybum marianum), to treat this liver condition, none are proven absolutely effective and safe. Other practices that may help boost your immune function and help make you feel stronger and less tired while taking conventional medications include homeopathy, acupuncture, and massage therapy. Make sure that the therapist knows that you have hepatitis so that the necessary precautions can be taken to avoid spread of the virus.

Your doctor will talk with you about measures you can take to keep from spreading the virus. For hepatitis A, these measures include: For hepatitis B and C, these measures include: If you are traveling to a high-risk country, take the following precautions: Other general lifestyle measures to take include:


Interferons – this group of medications are natural proteins that activate immune functions in the body and have anti-viral properties. These drugs do not work for everyone who takes them, but for those who do respond, the possible benefits include: Drawbacks for this class of drugs include: Corticosteroids – may be used in the early stages of chronic hepatitis to enhance the effects of interferon.

Nucleoside Analogues – this class of drugs, including lamivudine and ribavirin, are used to stop replication of the virus. Advantages of lamivudine, often used to treat chronic hepatitis B, over interferon include: Like interferon, nucleoside analogues can lose their effectiveness over time.

Ribavarin is often used in combination with interferon for chronic hepatitis C. Although ribavarin improves the response rate for those with hepatitis C, side effects from the interferon become more likely when this second drug is added. Potential side effects from the ribavarin itself include:

Surgery and Other Procedures

People with the following conditions may qualify for a liver transplant: Five-year survival rate after liver tranplantation is between 60% and 80%. Unfortunately, in about 50% of those with chronic hepatitis who receive a liver transplant, the infection recurs.

Nutrition and Dietary Supplements

Although no special diets have been shown to help treat acute hepatitis, eating small snacks during the day, with larger ones in the morning, may be recommended. Eating this way helps optimize digestion, prevent weight loss, and reduce nausea. Avoid drinking alcohol as this may further damage the liver.

Alpha-lipoic acid combination
There have been several case reports of use of alpha-lipoic acid in combination with silymarin (milk thistle) and selenium (a substance with liver-protecting and antioxidant properties) to help treat hepatitis C. Alpha-lipoic acid is an antioxidant that your body makes and is also available as a supplement. Experts suggest that additional alpha-lipoic acid may prove useful in the treatment of chronic hepatitis because it relieves stress on the liver and helps rid the body of toxins.

Cysteine (N-acetyl-L-cysteine [NAC])
Cysteine is an amino acid that can be found in many proteins throughout the body. This supplement is thought to help detoxify harmful substances in the body. Preliminary evidence suggests that NAC supplements may help treat hepatitis C when combined with standard medical therapy.

S-Adenosylmethionine (SAMe)
S-Adenosylmethionine or SAMe is a naturally occurring compound that is involved in many biochemical processes in the body. This chemical has been under investigation for many years in Europe for the treatment of liver disease. Preliminary research suggests that it may provide protection against liver damage and scarring and may improve survival rates in people with cirrhosis due to alcohol abuse. Animal studies also suggest that SAMe may protect the liver from damage after acetaminophen overdose (a pain-relieving medication purchased without a prescription). While the results for treating liver damage from either alcohol or acetaminophen over dose are encouraging, more research is needed to understand whether taking supplemental SAMe will impact viral hepatitis.

Selenium (found, for example, in fish, Brewer's yeast, wheat germ, garlic, whole grain,) is an essential mineral found in trace amounts in the body. Lower than normal selenium levels may be associated with an increased risk for liver cancer in people with hepatitis B and/or C. Low selenium levels may also worsen the toxic effects of alcohol on the liver. It is not clear, however, whether taking selenium supplements can help prevent or treat liver damage. There have been a few case reports of the use of selenium in combination with alpha-lipoic acid and silymarin (milk thistle) to help treat hepatitis C.

Spirulina is a type of blue-green algae found in most lakes and ponds. This supplement, which is thought to stimulate the immune system and have anti-viral effects, is considered a complete protein because well over half of it consists of amino acids -- the building blocks of protein. It is also a rich source of other nutrients including B complex vitamins, beta-carotene, vitamin E, carotenoids, manganese, zinc, copper, iron, selenium, and gamma linolenic acid (an essential fatty acid). There is some preliminary evidence suggesting that spirulina may help protect against liver damage and cirrhosis (liver scarring and failure) in those with chronic hepatitis. More research is needed in this area.

One small study suggests that zinc supplements may improve the response to interferon therapy in people with chronic hepatitis C. More research would be helpful.


Herbs, like medications, have potential side effects and may interact with prescription or over the counter drugs. They should, therefore, be used with caution and only under the guidance of a professionally trained and qualified herbalist. Milk thistle (Silybum marianum)
Milk thistle has been used since Greco-Roman times as an herbal remedy for a variety of ailments, particularly liver problems. Today, many professional herbalists recommend milk thistle extract for the prevention and/or treatment of various liver disorders including viral hepatitis. Several scientific studies lend support to this traditional use because they suggest that active substances in milk thistle (particularly silymarin) protect the liver from damage caused by viruses and a variety of toxins.

This early evidence is encouraging. However, despite the fact that milk thistle is widely used in the treatment of hepatitis (particularly hepatitis C), results from studies testing this use have been contradictory. Some researchers have found improvements in liver function in those with viral hepatitis taking milk thistle, while others have failed to detect these benefits. None of the studies have compared milk thistle with interferon or other conventional medications for this condition.

The bottom line is that more research is needed. In the interim, talk to your doctor about whether it is safe and worthwhile to try milk thistle for chronic hepatitis, particularly if medications did not work well for you or you could not tolerate the drugs due to side effects.

Licorice root (Glycyrrhiza glabra)
Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses, including liver disease. In one study of Japanese patients with hepatitis C, those who received intravenous treatment with glycyrrhizin (an active compound in licorice), cysteine, and glycine for an average of 10 years were significantly less likely to develop liver cancer and cirrhosis (scarring of the liver) than those who received placebo. In a second study of 57 patients with hepatitis C, glycyrrhizin significantly improved liver function after only one month. These effects diminished after glycyrrhizin treatment was discontinued.

Green tea (Camellia sinensis)
Results from several studies of animals and people suggest that one of the active ingredients in green tea, known as catechin, may help treat viral hepatitis. In these studies, catechin was isolated from green tea and used in very high concentrations. It is not clear at this time whether drinking green tea (which contains a lower concentration of catechins than the isolated forms used in these studies) confers these same benefits.

Others Other herbs that may be considered include:


There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for viral hepatitis based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Traditional Chinese Medicine (TCM)

When assessing a person with hepatitis, a TCM practitioner might make one of the following diagnoses: Once the diagnosis is established, the practitioner is likely to use acupuncture, moxibustion (a burning of an herb called mugwort over acupuncture sites), and herbal drugs to address the imbalances of hepatic qi and yin-yang.

A few scientific reviews of the use of Traditional Chinese herbal combination remedies have suggested that this is a valuable treatment approach for hepatitis B in particular. Further research is needed. One popular TCM herb, Phyllanthus amarus, was not supported in these reviews, however, as an effective therapy for viral hepatitis, despite popularity of its use for this purpose. Glycyrrhizin (an active compound in the herb licorice) is frequently used in TCM; see the earlier section entitled Herbs for more details about the use of this substance for viral hepatitis.

Other Considerations

Food handlers should be extremely careful in the case of hepatitis A and healthcare workers should always exercise universal precautions, as described earlier in the section entitled Prevention, to avoid contraction or transmission of hepatitis B or C.

Support groups are available for those with chronic hepatitis B or C. It is often difficult to cope with having this particular disease. Talking with people who also have this condition in a formal setting is often very helpful. Check with your doctor or area hospital to locate a support group near you.


Hepatistis B and hepatitis C can be transmitted during pregnancy or childbirth. Women who are pregnant or planning to become pregnant soon cannot take interferon or nucleoside analogues.

Warnings and Precautions

Because the liver processes many types of medications, you will most likely be advised to stop taking all drugs other than those recommended for treatment.

Similarly, certain herbs and supplements are known to cause harm to the liver:

Prognosis and Complications

In terms of the acute phase of hepatitis, jaundice generally disappears in two to eight weeks. Occasionally, hospitalization is necessary during the acute phase (for example, if you become significantly dehydrated), but most people completely recover. Full recovery of normal liver function tests, however, may take up to several months.

Rare yet serious complications of acute hepatitis include aplastic anemia (when the bone marrow makes no new cells) which can be fatal, pancreatitis, very low blood sugar, and polyarteritis (inflammation of blood vessels). Also quite rare is the acute phase of hepatitis leading to liver failure (called fulminant hepatitis) with bleeding from the gastrointestinal tract and brain damage, known as hepatic encephalopathy. Occasionally, the acute phase of hepatitis B or C is more mild yet prolonged, with recovery taking up to one year; 5% to 10% of people with this prolonged acute phase go on to develop chronic hepatitis.

After the acute phase, long term prognosis depends on many factors, including the cause of the hepatitis, whether you go on to become a carrier of type B or develop a chronic form of the disease, and whether you have any other underlying medical problems. Approximately 5% to 10% of people with hepatitis B become carriers and about 25% of carriers progress to chronic hepatitis. The vast majority of people infected with hepatitis C go on to become life-long carriers and anywhere from 50% to 90% of these carriers go on to develop chronic hepatitis.

The chronic form of hepatitis can ultimate lead to scarring of the liver (known as cirrhosis) and liver failure. There are two types of chronic hepatitis – chronic active and chronic persistent. The latter is mild and either doesn't get worse or only does so very slowly. Chronic active hepatitis, on the other hand, is much more likely to lead to cirrhosis, permanent damage to the liver. Cirrhosis occurs in 5% to 10% of those with chronic hepatitis from hepatitis B and as many as 20% to 30% of those with chronic hepatitis from hepatitis C. Approximately 14% of people with cirrhosis develop liver cancer.


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