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Viral hepatitis

Hepatitis is the inflammation (swelling) of your liver. It can be caused by certain medications, drinking too much alcohol, or more commonly, as a result of a viral infection. This is known as viral hepatitis. The most common types of viral hepatitis are hepatitis A, B and C.  

A map showing world hepatitis B distribution

Details

  • Types Types of viral hepatitis

    The most common types of viral hepatitis include:

    • hepatitis A
    • hepatitis B
    • hepatitis C

    Other types include hepatitis D and E, but they’re less common.

  • Symptoms Symptoms of viral hepatitis

    If you have hepatitis, you may not have any symptoms at all. If you do, they’ll vary depending on the type of hepatitis you have.

    Hepatitis A

    Most adults who have hepatitis A get symptoms. Symptoms come on around two to six weeks after you’ve been infected with the virus and initially include:

    • feeling sick (nauseous)
    • vomiting
    • abdominal (tummy) pain
    • fever
    • headache

    These symptoms come on quickly and last for around five to seven days. You may then start to develop a different set of symptoms. These may include:

    • dark urine – you’ll usually notice this first
    • pale or clay-coloured stool (faeces)
    • a yellow tinge to your skin, known as jaundice
    • itchy skin

    Hepatitis B

    If you have hepatitis B, you may or may not develop symptoms. Many people, when they’re first infected, don’t get any symptoms. If you do get symptoms, they may include things like:

    • a fever
    • chills
    • pain in your joints
    • a skin rash

    Other possible symptoms include jaundice, feeling sick, vomiting and pain towards the top right-hand side of your tummy, but these are less common.

    Hepatitis C

    Most people with hepatitis C don’t have any symptoms. If you have hepatitis C and do get symptoms, they may include jaundice or more general symptoms that aren’t very specific. These include:

    • feeling tired
    • muscle pain
    • joint pain
    • loss of appetite - this may lead to anorexia
  • Diagnosis Diagnosis of viral hepatitis

    Your GP will ask you about any symptoms you may have and discuss any risk factors which could mean you have been infected with a hepatitis virus. 

    Your GP will ask to take a sample of your blood and send it to the laboratory for some routine tests. Your blood sample will also be tested for specific antibodies, which may suggest you have a hepatitis infection. Antibodies are things that are made by your immune system, which help your body to fight infection. Your blood will also be tested for specific antigens. These are parts of the hepatitis virus that enable your immune system to recognise the virus and fight it. Depending on the results and the type of hepatitis, your blood might also be tested for other parts of the virus. You may also need to have an ultrasound scan of your liver.

    If a cause for your symptoms isn’t found, you may need to have further tests a few weeks later. 

  • Treatment Treatment of viral hepatitis

    Your treatment will differ depending on the type of hepatitis you have.

    Hepatitis A

    There isn’t a specific treatment for hepatitis A. If you have it, treatment is based around relieving your symptoms until your body clears the infection. This includes making sure you get enough rest and drinking plenty of water. It’s generally best to avoid taking pain relief and other medications to ease your symptoms. If you do need to take medications for pain, itchy skin or nausea, talk to your GP about this.

    Hepatitis B  

    If you have hepatitis B, your GP will refer you to someone who specialises in conditions to do with the liver. This could be a hepatologist, gastroenterologist or an infectious disease specialist who has an interest in hepatology. You may not have treatment immediately. Initially, your care will mainly involve managing your symptoms. Make sure you drink plenty of water and if you have itchy skin, try to:

    • wear loose clothes
    • keep cool
    • avoid hot baths or showers

    You should also avoid drinking alcohol.

    If you have chronic hepatitis B (you’ve had the infection for more than six months), your doctor may give you antiviral medicine to fight the virus. This can help prevent any further complications. There are two different groups of antiviral medicine used to treat hepatitis B:

    • interferon therapies (such as peginterferon alfa) 
    • nucleotide or nucleoside analogues (including entecavir and tenofovir disoproxil)  

    Your doctor will decide which treatment is most suitable for you. If your doctor prescribes peginterferon alfa, you’ll usually have this treatment for about a year. It comes as an injection which you’ll have once a week. If after four months of having this treatment there’s no improvement, your doctor may stop the treatment.

    If your doctor prescribes entecavir or tenofovir disoproxil tablets, you’ll need to take these daily. Always read the patient information leaflet that comes with your medication and take it as prescribed by your doctor. If after around six to nine weeks there’s no improvement, your doctor may suggest trying a different treatment option.      

    Hepatitis C

    If you have hepatitis C, your GP will refer you to a specialist. You may not have treatment immediately, as your body may fight the infection on its own. If your body fights the infection, it’ll usually happen within 12 weeks. During this time it’s important to take action to stop the disease from getting worse. If you smoke or drink alcohol, it’s a good idea to stop. For more information on how to stop, see our topics on stopping smoking and quitting drinking. You should also try to eat healthily and maintain a healthy weight. It’s also important to stop the infection from spreading to others. If you have hepatitis C, don’t share razors or toothbrushes, don’t donate blood, and always practise safe sex.

    If your body doesn’t fight the infection - you’ve had the infection for six months (chronic hepatitis C) - you’ll begin treatment with antiviral medicines. Which antiviral medicines you have and how long you need to take them for will depend on the specific type of hepatitis C virus you have. If you have chronic hepatitis C, your doctor will prescribe the most suitable medicine for you.  

    Always read the patient information that comes with your medication and take it as prescribed by your doctor.

  • Prompt access to quality care

    From treatment through to aftercare, with Bupa health insurance we aim to get you the help you need, as quickly as possible. Find out more today.

  • Causes Causes of viral hepatitis

    Hepatitis A, B and C are caused by the viruses outlined in the table below.

    Type Cause
    Hepatitis A Hepatitis A Virus (HAV)
    Hepatitis B Hepatitis B Virus (HBV)
    Hepatitis C Hepatitis C virus (HCV)
  • Complications Complications of viral hepatitis

    Complications, and how likely you are to get them, differ from one type of viral hepatitis to the next. Hepatitis A is associated with certain complications such as liver failure and problems with the flow of bile (a liquid made by your liver that helps break down the food you eat) known as cholestatic hepatitis. But the chances of you getting complications with hepatitis A are very low.

    Complications are slightly more common for hepatitis B and C. Some of these complications are outlined below. If you would like to know more about these complications and how they may affect you, talk to your GP.  

    Hepatitis B

    • Cirrhosis. If you have chronic hepatitis B, over time your liver may become damaged by the virus and develop scar tissue. This is known as cirrhosis.   
    • Hepatocellular carcinoma (HCC). HCC is a type of liver cancer and is a result of the damage and scaring caused to your liver over time – cirrhosis. If you have hepatitis B and cirrhosis and are an older man, you’re more at risk of HCC.

    Hepatitis C

    • Problems with your muscles and joints. This is the most common complication and includes things like muscle and joint pain, and arthritis.
    • Cirrhosis. If you have chronic hepatitis C, over time your liver may become damaged and develop scar tissue - cirrhosis. If you have hepatitis C and cirrhosis, you’re at an increased risk of getting HCC.   
    • Skin problems. Hepatitis C may cause blisters or a rash on your skin.
    • Cryoglobulinaemia. This is when the things fighting your infection (antibodies) build up and deposit themselves around your body.
  • Prevention Prevention of viral hepatitis

    There are things you can do to minimise your chances of getting viral hepatitis. They include avoiding things that put you at risk of getting infected, or having a vaccine to protect you from the infection in the first place.

    Hepatitis A

    Hepatitis A is spread from one person to another by putting something in your mouth that has come into contact with contaminated faeces. Such things include water and food (such as shellfish). To prevent hepatitis A, always cook food properly and make sure you wash your hands thoroughly before preparing food and after going to the toilet. This is important because hepatitis A virus can survive on the ends of your finger tips for up to four hours.

    If you’re a man who has sex with other men, you may be more at risk of hepatitis A. For this reason, it’s important to practise safe sex. You may also be offered a vaccine to protect you from hepatitis A. Other people who are at a high risk of getting hepatitis A will also be offered hepatitis A vaccine. This includes people living in, or travelling to, areas that have hepatitis A. 

    Hepatitis B

    Hepatitis B is spread through blood or other bodily fluids. You could be at risk of Hepatitis B if, for example, you take drugs that you inject or have sex with someone who is infected. If you’re at risk of getting hepatitis B, you can have a vaccine to protect you from the virus. There are different vaccines and vaccination schedules available. For more information about these, talk to your GP.

    Hepatitis C 

    Most cases of hepatitis C are caused by people injecting themselves with illegal drugs. To prevent yourself from getting hepatitis C, you should avoid doing this. You should also try to avoid contact with blood. If you are considering getting a tattoo or having your ears pierced, make sure you choose a licensed practitioner to get it done. Although hepatitis C isn’t usually spread by having sex with someone who is infected, it’s best to practise safe sex and wear a condom.

    There isn’t a vaccine currently available to protect you against hepatitis C.

  • FAQ: Hepatitis and pregnancy I’m pregnant and have hepatitis, will my child have it?

    It’s possible that your child will have the condition, but it depends on which type of hepatitis you have.

    More information

    If you’re pregnant and have hepatitis A, it’s very unlikely that you’ll pass it to your child. If you have the infection, your body makes things called antibodies to fight the infection. These antibodies pass through the placenta to your child and protect them from the infection.

    Hepatitis B can pass between you and your child through blood and other body fluids when you give birth. However, if you have hepatitis B, there’s no reason why you can’t have children as your child will have a vaccination to protect them from the virus when they’re born. If you have hepatitis B and have lots of the virus in your blood, you may be offered antiviral drugs in your third trimester. This will lower the amount of hepatitis B virus in your blood and reduce the chance of you passing it to your child in the first place.

    If you’re pregnant and have hepatitis C, the chance of you passing the infection to your child is quite low. However, the more virus you have in your blood, the greater the chance of this happening. Having HIV (human immunodeficiency virus) as well increases the chance of you passing hepatitis C to your child.  

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Stedman’s Medical Dictionary. Lippincott Williams & Wilkins. www.medicinescomplete.com, accessed March 2016
    • Drug induced hepatitis. PatientPlus. www.patient.info/patientplus, last checked July 2015
    • Alcoholic hepatitis. Medscape. emedicine.medscape.com, updated December 2015
    • Viral hepatitis. Medscape. emedicine.medscape.com, updated December 2014
    • Viral hepatitis (particularly D and E). PatientPlus. www.patient.info/patientplus, last checked March 2014
    • Hepatitis A. BMJ Best Practice. bestpractice.bmj.com, last updated June 2015
    • Hepatitis A. World Health Organisation. www.who.int, updated July 2015
    • Hepatitis A. PatientPlus. www.patient.info/patientplus, last checked December 2013
    • Hepatitis B. World Health Organisation. www.who.int, updated July 20515
    • Hepatitis B. BMJ Best practice. bestpractice.bmj.com, last updated December 2015
    • Hepatitis C. PatientPlus. www.patient.info/patientplus, last checked April 2015
    • Hepatitis C. BMJ Best Practice. bestpractice.bmj.com, last updated September 2015
    • Hepatitis B. PatientPlus. www.patient.info/patientplus, last updated August 2013
    • Hepatitis A. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2014
    • Hepatitis B. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2014
    • Hepatitis C. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2016
    • Map of Medicine. Hepatitis A. International View. London: Map of Medicine; 2011 (Issue 2)
    • Map of Medicine. Hepatitis B. International View. London: Map of Medicine; 2014 (Issue 3)
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed March 2016
    • Map of Medicine. Hepatitis C. International View. London: Map of Medicine; 2014 (Issue 1)
    • Cirrhosis. BMJ Best Practice. bestpractice.bmj.com, last updated September 2015
    • Hepatocellular carcinoma. Medscape. emedicine.medscape.com, updated September 2015
    • Porphyria cutanea tarda. Medscape. emedicine.medscape.com, updated March 2016
    • Lichen planus. Medscape. emedicine.medscape.com, updated March 2016
    • Cryoglobulinaemia. BMJ Best practice. bestpractice.bmj.com, last updated June 2015
    • An update on viruses in the food chain. Advisory Committee on the Microbiological Safety of Food. www.food.gov.uk, March 2015
    • Hepatitis in pregnancy. Medscape. emedicine.medscape.com, updated March 2016
    • Hepatitis B. National Institute for Health and Care Excellence (NICE), published July 2014. www.nice.org.uk
    • Pan C, Lee H. Antiviral therapy for chronic hepatitis B in pregnancy. Semin Liver Dis 2013; 33(02):138–46. doi:10.1055/s-0033-1345718
    • Personal communication, Professor Martin Wiselka, Consultant in General Medicine and Infectious Diseases, May 2016
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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Heath Content Team, March 2016.
    Peer reviewed by Professor Martin Wiselka, Consultant in General Medicine and Infectious Diseases.
    Next review due March 2019.

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