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|
- Flu-like symptoms including fever, as well as aching or painful
muscles and joints.
- Jaundice (yellow discoloration of both your skin and the whites of
- Abdominal discomfort
- Loss of weight
- Loss of appetite
- Nausea, vomiting
- Dark urine, colorless stool
- Whole body itching (called pruritus)
- Mild anemia
- Enlarged, tender liver
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.
- Chronic institutionalization (nursing home or rehabilitation center)
- Day care employees or children
- Recent hepatitis A infection in a family member
- Recent travel or immigration from Asia, South or Central America
- Food industry workers
- Sewage workers
- Contact with blood in work setting: this puts physicians, nurses,
dentists, and other healthcare personnel at particular risk
- Sex with multiple partners without the use of a barrier such as a
- History of blood transfusion prior to the early 1990's
- Receiving a tattoo with contaminated instruments
- IV drug use with sharing of contaminated needles
- Birth to a hepatitis B infected mother
- Travel to underdeveloped nations and immigrants from areas where
disease rates are high (namely, the Asia Pacific and Mediterranean regions and
- Having the human immunodeficiency virus (HIV) puts you at greater risk
for chronic hepatitis and its potential complications
- Blood transfusion prior to July 1992
- Solid organ transplantation from a donor who has hepatitis C
- IV drug use and sharing of contaminated needles
- Long-term kidney dialysis
- Contact with blood in work setting: this puts physicians, nurses,
dentists, and other healthcare personnel at particular risk
- Sex with a person who has hepatitis C
- Birth to a hepatitis C infected mother, particularly if she has HIV
- Having HIV or hepatitis B puts you at greater risk for chronic
hepatitis C and its potential complications
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
- Work in health care setting, including either a medical laboratory or
a dialysis unit
- Have a parent, sibling, or child infected with hepatitis
- Engage in unprotected sex or have a sexual partner with either
hepatitis B or C
- Use drugs by injection
- Live in or are exposed to unsanitary conditions
- Consume possibly contaminated food or water
- Eat or handle raw shellfish
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.
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:
- Avoid unclean food and water
- Wash hands thoroughly after using the toilet or changing a diaper, as
well as before serving food
- Clean yourself thoroughly if you come into contact with any type of
body fluid from an infected person (such as blood and feces)
- Those with the virus should not prepare food for
Hepatitis B and C
Preventive measures are the same for both hepatitis B and C.
- Avoid contact with blood or blood products whenever possible
- Do not inject drugs of abuse, and especially do not share needles with
- Avoid having multiple sexual partners
- Practice safer sex behaviors, including use of appropriate barrier
methods such as condoms
- Go to a reputable shop for tattoos and body piercing
- Healthcare workers should practice universal precautions when handling
blood and bodily fluids; this includes wearing gloves when performing any
procedure with blood exposure, disposing of needles properly, and many other
precautions, depending on your specific role.
Candidates for the hepatitis A vaccine include:
- Anyone who lives or works in a community where outbreaks occur (such
as a daycare center)
- Those who travel frequently or have long overseas stays in high-risk
- Sexually active homosexual men
- People who already have a chronic form of hepatitis; should be
vaccinated against hepatitis A before the chronic form reaches late stages of
- Healthcare workers
- Those living in high-risk U.S. states, which include Alaska, Arizona,
Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico,
Oklahoma, Oregon, South Dakota, Utah, Washington, and Wyoming
- Those with intimate exposure to someone with hepatitis A; in this
case, your doctor will decide if the vaccine or immunoglobulin (an immunizing
agent) is most appropriate. This depends, in part, on the timing of the
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:
- Those who live with someone with hepatitis B
- Healthcare workers
- Travellers to high-risk areas
- Sexually active people who have multiple partners
- People on hemodialysis
- People who have suppressed immune systems (such as HIV)
- High-risk pregnant women
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.
The goals for treating acute viral hepatitis include:
- Assuring adequate nutrition and hydration
- Preventing further damage to the liver
- Avoiding transmission of the virus to others.
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
The goals for treatment of chronic viral hepatitis include:
- Preserving liver function and preventing liver damage
- Boosting the immune system to help fend off damage from the virus
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
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:
- Washing clothes thoroughly with hot water
- Washing your hands after using the toilet
- Heating contaminated articles for one minute, which should kill the
- Using household bleach for disinfecting hard surfaces
- Separating the eating and cooking utensils used by the household
member with the virus from those used by other people living there
- Abstaining from sexual activity while acutely infected
For hepatitis B and C, these measures include:
- Avoiding sharing personal items such as toothbrushes and razors
(microscopic blood particles may be on these items)
- Abstaining from sexual activity, or taking strict precautions such as
always using a condom. Women should abstain during menstruation in particular.
- Handling objects contaminated with blood with special care, like
wearing gloves when drawing blood if you work in a hospital
- Not sharing drug needles if you use street drugs intravenously and
making sure that tatoo artists, body piercers, and acupuncturists use sterile
needles. (Note: due to the standard use of sterile, disposable needles by
licensed acupuncturists, there have been no reports of hepatitis infection from
acupuncture therapy in the United States.)
If you are traveling to a high-risk country, take the following
- Get vaccinated against hepatitis A and possibly hepatitis B
- Use bottled water for drinking and brushing teeth
- Eat heated food promptly. Heated food should be hot to the touch.
- Avoid buying food from street vendors
- Avoid sliced fruit. It may have been washed in contaminated water.
- Avoid raw or undercooked fish and shellfish
Other general lifestyle measures to take include:
- Don't drink alcohol during the acute phase of hepatitis or if you
become a carrier of types B or C.
- Quit smoking because new evidence suggests that cigarette smoking is
associated with more severe infection.
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:
- Diminished viral levels of hepatitis B and C
- Reduced symptoms
- Improved survival rates
Drawbacks for this class of drugs include:
- Need to administer via injection
- Hepatitis B and C can become resistant to the medication; in other
words, the drugs become ineffective over time
- Side effects from the interferons are often very unpleasant, even
intolerable to some people as they may be worse than the symptoms from chronic
hepatitis itself (particularly since some people with hepatitis C have no
symptoms). Common side effects are flu-like symptoms including fever, chills,
and muscle aches. Additional side effects include depression, hair loss, weight
loss, and drop in white blood cells (the cells in the body that help fight
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
- Can be taken orally
- Fewer side effects
- Less expensive
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:
- skin disorders
- coughing and shortness of breath
- sleep disturbance
- depression or anxiety
- weight loss
|Surgery and Other Procedures|
People with the following conditions may qualify for a liver
- Life-threatening cirrhosis and life expectancy is, otherwise, more
than 12 years
- Liver cancer that remains confined to the liver
- Fulminant acute hepatitis
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 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
One small study suggests that zinc supplements may improve the response to
interferon therapy in people with chronic hepatitis C. More research would be
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
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
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.
Other herbs that may be considered include:
- Turmeric (Curcuma longa) -- in animal studies, turmeric has
been shown to have a protective effect on the liver. This may be related to
turmeric's ability to help clear toxins. It is not known whether or not such
liver protection applies to people.
- Astragalus (Astragalus membranaceus) -- has been used in
traditional Chinese medicine for thousands of years. This herb is also used for
its immune enhancing properties, especially for the prevention and treatment of
the common cold and chronic hepatitis.
While research in China has shown some promise in treating hepatitis B, few
acupuncturists in the United States provide treatment for this or other forms of
hepatitis. Acupuncture is generally used in China and other countries to boost
the immune system of those with hepatitis.
There has been some concern that patients could contract hepatitis from dirty
needles and/or infected practitioners. However, there have been no reported
incidents of infection in the U.S. Because of the customary use of sterile,
disposable needles by acupuncturists in the U.S, there is virtually no risk of
contracting hepatitis from acupuncture therapy here or other countries with
|Massage and Physical Therapy|
Therapeutic massage may be helpful in enhancing immune
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.
- Aconitum — used during initial phases
of hepatitis when the individual has a fever, jaundice, and sharp pains in the
liver; can be used in newborns
- Belladonna— used in early stages of
hepatitis when the individual has occasional liver pains that are worsened by
inhalation and movement
- Chelidonium— for individuals with pain
that originates in the liver and extends to the back and right shoulder; this
remedy is most appropriate for individuals who have gray or yellow loose stools,
fever, and jaundice; a craving for milk may be present; lying on the left side
and ingesting hot food or drink may bring some relief
- China— for individuals with a tender
liver and a sensation of fullness in the stomach; the individual may burp
frequently although it provides no relief; he or she may also have cravings for
sweets, cold drinks, or coffee
- Lycopodium— one of the primary
remedies for hepatitis in children and adults; this remedy is most appropriate
for individuals who feel tension in the liver area, have difficulty standing up,
and feel full after eating only small amounts of food
- Mercurius— for individuals with a
swollen, tender liver and jaundice; the tongue may also be yellow and swollen;
this remedy is most appropriate for individuals with clammy perspiration,
excessive salivation, a sensitivity to temperature variations, and bleeding
gums; lying on the right side is painful and stools may be light gray or green
- Phosphorus— for individuals with
burning pains under the right rib cage and in the back between the shoulder
blades that are relieved by cold drinks; this remedy may be used in newborns
Traditional Chinese Medicine (TCM)
When assessing a person with hepatitis, a TCM practitioner might make one of
the following diagnoses:
- Hepatic qi stasis
- Hepatic yang excess with yin deficiency
- Hepatic yin insufficiency
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.
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
Similarly, certain herbs and supplements are known to cause harm to the
- Kava kava (an herb used for anxiety and tension) can be toxic to the
liver and cause severe hepatitis and even liver failure if taken excessively.
Liver-related risks have prompted regulatory agencies in other countries,
including Germany, Switzerland, France, Canada, and the United Kingdom, to warn
consumers about the potential risks associated with kava use and to remove
kava-containing products from the marketplace. Similarly, the United States FDA
issued an advisory in March of 2002 regarding the potential risk of liver
failure associated with kava-containing products, but this herb has not been
taken off the market in this country.
- Vitamin A in large quantities can be toxic 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
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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|Review Date: December 2002|
|Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and
Senior Medical Editor A.D.A.M., Inc.; Dahlia Hirsch, MD, Center for Holistic
Healing, BelAir, MD; Joseph Lamb, MD, The Integrative Medicine Works,
Alexandria, VA; Marc Micozzi, MD, PhD, College of Physicians, Philadelphia, PA;
Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's
Catholic Medical Center, New York, NY;Leonard Wisneski, MD, FACP, George
Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, (Acupuncture
section October 2001) President and Chairman, Hawaii State Consortium for
Integrative Medicine, Honolulu, HI.|
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