American Medical Association Family Medical Guide - American Medical Association [517]
• If you are exposed to hepatitis B and have been vaccinated, see your doctor for a blood test to detect hepatitis B antibodies, which indicate infection.
Chronic Hepatitis
The risk of developing progressive, chronic hepatitis is greater with the hepatitis B and C viruses than with the others. Up to half of all people who are infected with hepatitis C go on to develop chronic hepatitis C and are more likely to have liver disease eventually. Hepatitis C is the leading cause of chronic hepatitis and cirrhosis worldwide, and the leading reason for a liver transplant in the United States.
Q & A
Hepatitis
Q. My friend told me that you can get hepatitis B or C from donating blood or having a blood transfusion. Is this true?
A. No. You cannot get hepatitis or any other infectious disease from donating blood; a new, sterilized needle is used to draw blood from each donor. You are very unlikely to get hepatitis B or C from a blood transfusion with donated blood because all donor blood in the United States is screened for the viruses.
Q. Can any of the hepatitis viruses be transmitted sexually?
A. Yes. Hepatitis B is more likely to be transmitted through sexual activity than hepatitis C or hepatitis A. Hepatitis B—which is found in blood, semen, and vaginal fluids—is a common sexually transmitted disease and is much more infectious than HIV (the virus that causes AIDS). If you or your partner is infected with hepatitis B, always practice safe sex. The partner who is not infected should have a hepatitis B vaccination. Once a follow-up blood test shows that his or her body has produced antibodies to fight the hepatitis B virus, he or she is protected from the infection for life. Hepatitis C is rarely transmitted sexually. Hepatitis A, which is present in an infected person’s feces, can be spread through anal-oral sexual contact.
Q. Is there a hepatitis E? I never heard of it before.
A. Yes, but it is extremely rare in the United States. Nearly all cases in the United States occur in people who have traveled to countries in which the virus is widespread, especially developing countries that have inadequate sanitation systems. Like hepatitis A, the hepatitis E virus is spread in feces, often in contaminated drinking water, and it causes similar symptoms. However, unlike hepatitis A, hepatitis E is not transmitted easily from person to person. There is no vaccination for hepatitis E. If you travel to a developing country, drink bottled water, don’t put ice in your drinks, and avoid uncooked shellfish and uncooked fruits or vegetables that are peeled or prepared by someone else. During pregnancy, especially in the second or third trimester, a hepatitis E infection can be severe and is more likely to lead to liver failure in the woman.
Many people, however, develop chronic hepatitis without being infected with the virus. For example, autoimmune hepatitis is triggered in some people when their immune system mistakenly attacks the liver. In other people, hepatitis results from a severe reaction to a medication.
Chronic hepatitis is classified into two main types—chronic persistent hepatitis and chronic active hepatitis. In both diseases, the body responds with a faulty immune response that can damage cells in the liver. Chronic persistent hepatitis progresses slowly over a period of 10 to 40 years, but is unlikely to progress to cirrhosis (see next page).
Chronic active hepatitis is less predictable—in many cases, a steady, progressive destruction of liver cells leads to cirrhosis. The severity of chronic active hepatitis can vary from person to person. Some people have no symptoms for long periods but occasionally have episodes of jaundice (yellowing of the skin and whites of the eyes; see page 785), pain in the joints, nausea, fever, and loss of appetite. In some people, the disease comes and goes and does not respond to treatment. In others, the disease