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In rare cases, people with chronic hepatitis B have flare-ups of illness caused by hepatitis D, also called the Delta virus, which affects only people who are already infected with hepatitis B. Having a hepatitis B vaccination prevents hepatitis D.

Diagnosis

Blood tests can indicate whether you are infected with hepatitis B or C. Your doctor will diagnose a form of chronic hepatitis if your health does not return to normal after an acute attack of jaundice and if liver function tests continue to be abnormal. If you are diagnosed with chronic hepatitis C, the doctor will test the levels of two liver enzymes—alanine aminotransferase (ALT) and aspartate aminotransferase (AST)—that are released when liver cells are injured or die. These levels can fluctuate from elevated to normal during the illness. If your liver enzyme levels are normal, your doctor will test them regularly over a 6- to 12-month period. If your enzyme levels continue to be normal during this time, he or she may recommend blood tests less frequently, such as once a year. Your doctor may order a liver biopsy (examination of a small sample of tissue taken from the liver for examination under a microscope) to help evaluate your condition and determine appropriate treatment.

Treatment

Depending on your general health and the results of the liver biopsy, your doctor may be able to determine if the disease is likely to clear up without treatment. If the results of blood tests and a liver biopsy show that the disease could progress to cirrhosis, your doctor will recommend treatment based on whether you have hepatitis B or C. In either case, the doctor will recommend that you have a vaccination against pneumonia (see page 660), hepatitis A, and hepatitis B (if you have hepatitis C) to prevent further strain on your liver. (There is no vaccination for hepatitis C.)

To treat chronic active hepatitis B, a doctor will prescribe an antiviral medication such as interferon alfa-2b or lamivudine. Injections of interferon are usually given for 4 to 6 months. Interferon can cause a number of side effects including fatigue, headache, nausea and vomiting, loss of appetite, depression, and thinning hair. Because interferon can depress the blood cell-producing bone marrow, you will have regular blood tests to measure your blood cell levels. Lamivudine is taken by mouth for at least a year. Lamivudine is not quite as effective in eliminating hepatitis B as interferon and, in some cases, the virus becomes resistant to lamivudine.

To treat chronic hepatitis C, a doctor may prescribe an antiviral medication such as interferon or ribavirin, often in combination. Interferon is given by injection; ribavirin is taken by mouth. The side effects of ribavirin include sudden, severe anemia (see page 610) and birth defects; for this reason you should not get pregnant or get anyone pregnant while you are taking ribavirin and for 6 months after your treatment ends.

Many people with chronic hepatitis C respond to treatment at least temporarily, and some of them become virus-free after 6 months of therapy. In others, however, the disease progresses over a period of 30 to 40 years to cirrhosis and eventually liver failure. A liver transplant (see next page) is frequently recommended for people who have end-stage hepatitis C.

Liver Transplants

In liver transplantation, a diseased liver is removed and replaced with a healthy liver (or part of a liver) from a donor. About 80 to 90 percent of people survive liver transplant surgery. Survival rates have improved over the past several years thanks to drugs such as cyclosporine and tacrolimus, which suppress the immune system to prevent it from attacking and damaging the donor liver.

Transplants are usually recommended for people whose liver has been severely damaged by chronic cirrhosis or for children who have congenital (present at birth) abnormalities of the bile ducts. Transplants can be successful in people who stop drinking alcohol permanently. However, a transplant is not