Key Points About Alcoholic Hepatitis
- Hepatitis is inflammation of the liver that leads to liver cell damage and cell death.
- Alcoholic hepatitis is caused by drinking too much alcohol. The liver breaks down alcohol and if, over time, you drink more alcohol than the liver can process, it can become seriously damaged.
- Alcoholic hepatitis usually develops over time with continued drinking. Severe alcoholic hepatitis can develop suddenly and quickly lead to liver failure and death.
- You must completely stop drinking alcohol and may need an alcohol treatment program. Sometimes diet changes are recommended, too. Treatment involves reducing the symptoms and halting the progression of the disease.
If I Get Tested For Hepatitis C And The Result Is Positive Do I Need Any Other Tests To Be Sure
When your provider wants to test you for hepatitis C, the first test you will have is the hepatitis C antibody . If this test is positive, it means you were infected with the hepatitis C virus at some point in the past. But this test alone is not enough. You will still need another test to confirm if you still have the hepatitis C virus in your system. About 1 out of 5 people who get infected with hepatitis C will be able get the rid of the virus on their own, without treatment, very early after their infection. So some people will have a positive antibody test, but a negative HCV RNA .
So, the second test that your provider should request is called hepatitis C virus RNA or HCV RNA test. There are several different tests available to check the HCV RNA. What matters is that if the RNA test is positive, then you do have chronic hepatitis C virus infection. If the RNA test is negative, then you may need to have this test again to be sure. If these RNA tests are all negative, then you no longer have hepatitis C infection and do not have chronic hepatitis C.
If your hepatitis C antibody test is positive, be sure that you get tested for hepatitis C RNA to find out whether the infection has become chronic or whether it has cleared. If the infection has become chronic, there are treatments your provider can prescribe to fight off the hepatitis C virus and keep your liver healthy.
If You Have Hepatitis C Can You Have Sex Without Infecting Your Partner
Hepatitis C is a virus that is transmitted by blood. The most common ways people become infected with hepatitis C are through needle sharing, such as during injection drug use, or from blood transfusions received before 1992.
Becoming infected from sex is not common, but it does happen. If you have hepatitis C, the chance of infecting a sex partner is higher if you are with a new partner or if you have had many different partners over time. If you have hepatitis C, the chance of infecting a sex partner is lower if you are with a longtime stable partner and if you are in a monogamous relationship.
If your sex partner is new to you, or if you have many different partners, it is safer if you use condoms during sex to reduce the chance of transmitting hepatitis C.
It is always best to talk directly with your health care provider to assess whether you should start using condoms. If you are in a sexual relationship and either you or your partner has hepatitis C, the other partner should be tested for hepatitis C and other sexually transmitted viruses once a year, or as advised by your provider.
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What Is The Difference Between Relapse And Nonresponse
The goal of treating chronic hepatitis C is to completely clear the virus. This means that your “viral load” is zero or so low that the virus can’t be detected with standard blood tests.
Without treatment, the hepatitis C virus in liver cells constantly makes copies of itself, and the virus ends up not just in liver cells but also in the bloodstream. Treatment is intended to completely stop reproduction of the virus so that it doesn’t continue to enter the bloodstream or cause any more injury to liver cells.
Successful treatment results in a “sustained virological response.” This means the virus becomes completely undetectable before the treatment is finished, and it remains undetectable for 6 months after treatment is stopped.
A “relapse” means the viral load drops to an undetectable level before treatment is completed, but becomes detectable again within 6 months after treatment is stopped. Even if the virus returns at a level that is lower than it was before treatment, a relapse is still considered to have occurred. A relapse can be determined if the viral load starts to rise during treatment, or at any time after the virus becomes undetectable.
A “nonresponse” means the viral load never drops significantly and the virus remains detectable throughout the course of treatment.
Diagnosis Of Hcv Infection
HCV liver disease was confirmed in each patient by the detection of anti-HCV antibody in serum tested by second generation radioimmunoblot assay or serum HCV RNA by the the polymerase chain reaction. All patients with hepatitis B surface antigen positivity and immunological disorders of chronic liver disease were excluded from our study. Patients who had not received interferon therapy before liver biopsy were included in this study. HCV RNA was measured in serum by the signal amplification technique employing branched deoxyribonucleic acid in a sandwich hybridization assay . Serum HCV RNA titres were expressed as mega equivalent copies of viral genome per millilitre of serum .
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Demographic And Biochemical Data
There was no difference in the age of all male patients in the alcohol and alcohol-free groups . The median alcohol intake for Groups A and D was similar and was considered indicative of heavy alcohol consumption. The median alcohol intake for Group C was 65 g/day and this was considered as a group of moderate alcohol consumption. The AST/ALT ratio was > 1 for Group A, but was < 1 for the other groups. We did not find any significant difference in the serum levels of other biochemical parameters in these four groups except gamma-glutamyl transpeptidase and leucine aminopeptidase , which showed a higher value in Group A compared to the other groups .
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Tests For The Hepatitis C Virus
If your doctor thinks that you may have hepatitis C, he or she may order:
- A hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus.
- A blood test that looks for the genetic material of the hepatitis C virus. This test shows whether you are infected with the virus now.
- A blood test to find out the kind of hepatitis C virus you have. Knowing your genotype will help you and your doctor decide if and how you should be treated.
How Does Hepatitis C Progress
When someone is first infected with hepatitis C, most likely they have no symptoms and are unaware. Occasionally people experience fatigue, loss of appetite, weakness or sometimes having a yellow color in their skin or eyes. Although having any symptoms at all is rare, if they do occur, they usually go away within a few weeks.
Around 15-25% of people who are infected will spontaneously fight off the virus on their own and they will not have a chronic hepatitis C infection and no long term damage occurs.
But around 75-85% of people will develop chronic infection. Most of the time, people with chronic hepatitis C have no symptoms at the time of infection and no symptoms for years or even decades of chronic infection. The virus will be with them until they are successfully treated with hepatitis C medications.
Around 10-20% of people with chronic infection will slowly have gradual damage in the liver over years and will eventually develop cirrhosis . This can take 20 years or more from the time of the initial infection.
Cirrhosis is the replacement of liver cells with permanent scar tissue. Cirrhosis can lead to problems such as bleeding from veins in the esophagus, fluid buildup in the belly, and damaged brain function.Approximately 15% of people with cirrhosis will develop liver cancer during their lifetime. Drinking excessively can double the chance of liver cancer in people infected with HCV.
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Increased Risk Of Cirrhosis
There is little doubt that people with chronic hepatitis C who drink alcohol have a higher chance of developing cirrhosis. From an epidemiological point of view, more than 90% of heavy drinkers will develop fatty liver disease, of which as many as 20% will develop liver cirrhosis within 10 to 20 years.
Hepatitis C infection runs a similar course, with 75% of infected persons developing chronic disease, while 15-20% will progress to advanced disease within 10 to 30 years.
The combination of these two factors speeds the process dramatically, as well as increasing the severity of liver damageby some estimates, by as much as 200-300%. Furthermore, heavy alcohol users with HCV have a nearly 11-fold greater risk of developing cirrhosis than non-drinkers with HCV.
Will The Baby Be Infected If The Mother Or Father Has Hepatitis C
The baby’s risk of becoming infected with hepatitis C in the womb varies, depending on whether the parent with hepatitis C is the father or the mother.
If the mother is infected, whether or not the father is infected, there is a 5% chance that the baby will be born with hepatitis C. The risk is the same regardless of whether the birth occurs by vaginal delivery or by cesarean section. The risk is higher if the mother is also living with HIV.
If the father has hepatitis C but the mother does not, the baby cannot become infected because a father cannot pass the virus directly to a baby. If the father first passes the virus to the mother through sex, then the baby possibly could be infected by the mother. However, the chance of the virus being transmitted both from father to mother and then from mother to baby is almost zero.
All children born to HCV-infected women should be tested for HCV infection. Testing is recommended using an antibody-based test at or after 18 months of age. Approximately 25-50 % infants with hepatitis C will clear the infection without any medical help by age 4. For those who become chronically infected, most have no symptoms .
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Alcohol & Liver Disease
Red wine every night for practically 20 years had damaged my liver severely. I was in the early stages of cirrhosis, and that terrified me enough to stop. It must have been when Id injected heroin almost 20 years ago that Id contracted hep C. Simon
Alcohol is the most abused substance in the United States. Sixty-one percent of Americans drink alcohol. Ten to 12% of them are considered heavy drinkers.
All that alcohol goes to the liver, the organ responsible for breaking down alcohol. If you consume too much, the liver can be overwhelmed. And, if this continues long enough, liver disease can be the result.
In fact, the more you drink and the longer you drink, the more likely you are to develop liver disease.
Needle Use Or Accidental Stick
You can get hepatitis C from:
- Sharing needles and other equipment used to inject drugs.
- Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
- Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.
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Relation Of Duration And Mode Of Hcv Infection With The Development Of Cirrhosis
We obtained a history of blood transfusion in 41 patients of Groups B, C and D . We found that there was no significant difference in the number of patients with blood transfusion, duration of HCV exposure, and frequency of liver cirrhosis in these three groups of patients. However, the patients of Group D developed cirrhosis a little faster than those of Group B , although not significantly .
Who Can Be Treated For Hepatitis C
Treatment decisions should be made by both you and your provider. Current treatments for hepatitis C are very successful and can cure most people of the virus.
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Directions For Future Research
A recent National Institute on Alcohol Abuse and Alcoholism conference identified areas of research with the greatest potential for leading to more effective treatment options. Conference recommendations for research within these areas were as follows:
Clinical Studies
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Determine how variations in the amount and pattern of drinking, combined drinking and smoking, and nutritional deficiencies affect HCVinfected patients risk of liver injury, disease progression, and death.
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Evaluate the effectiveness of alcohol cessation programs in patients with HCV.
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Specify how alcohol affects patients response to interferon treatment, including chemical interactions and daytoday changes in virus activity during treatment.
HCV Virology
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Determine how alcohol affects viral replication, clearance, and persistence and the evolution of new HCV quasispecies.
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Examine whether alcohol use leads to greater dominance of more harmful genetic variants of HCV.
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Determine whether alcohol interacts with the HCV viral proteins to alter the viruss genetic activity.
Immunology
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Identify the effects of alcohol on immune responses to HCV, including changes in quality, behavior, and survival of immune cell populations both within and outside the liver.
Mechanisms of Liver Injury
Model Systems
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Develop animal models of HCV infection and of alcoholic liver disease that reproduce disease processes found in humans.
What Is A Biopsy
A biopsy is a medical procedure. A tiny piece of liver is removed and examined to find out the extent of damage. It involves a large needle and local anesthetic, as well as some risk of bleeding. A pathologist looks at the piece of liver under microscopes to determine how much damage has occurred in the liver. This is a very useful test and used to be done very commonly. However, the procedure is done much less frequently than in the past. For most patients with hepatitis B and C, liver biopsy is not required. Today, other tests can be used to try to estimate the fibrosis in the liver.
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What Is Hepatitis C
Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to cirrhosis, liver cancer, and liver failure.
Many people don’t know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.
What Does High/low Viral Load Mean
Viral load is the amount of virus present in the bloodstream. It is expressed as the amount of viral genetic material per milliliter of blood. The amount of virus does not predict how severe the liver disease is or will become. The level of the viral load does not tell us anything about the risk of liver damage or how sick someone is. In hepatitis C, it matters if virus is present or absent. Some treatment regimens can be shortened if the patient has a low viral load to start with, but most often, treatment regimens are the same for people with high hepatitis C viral loads or low viral loads.
The RNA test is essential for making the diagnosis of hepatitis C infection–having a positive RNA test is the definition of having infection. After the diagnosis is made, the RNA level does not need to be checked over and over unless it is checked during the time that the patient is undergoing treatment. During treatment, regular RNA tests are done to follow the dropping virus level until it reaches an undetectable state. But before treatment and after treatment, repeated RNA testing is not necessary.
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Autoimmune Hepatitis With Jama Darling Md
This is Episode Six of Autoimmune Disease: Pieces of the Picture. Dr. Jama Darling talks about autoimmune hepatitis, the importance of liver biopsy, how it is different from other types of hepatitis, and treatments of the disease. Dr. Darling is an Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology.
When we have diagnosed a patient with autoimmune hepatitis, one of the most common questions I get is, Ive never done drugs or had a blood transfusion. I dont drink alcoholwhy on earth do I have hepatitis?I explain to the patient that they dont have a virus, they dont have a blood-blood transmission virus like hepatitis C, it isnt due to a behavior such as excess alcohol intake.. Their immune system is recognizing something in the liver as unwanted and trying to get rid of it, and this is of no fault of their own.
Jama Darling, MD
Ron Falk, MD: Hello, and welcome to the Chairs Corner from the Department of Medicine at the University of North Carolina.
Welcome to our series where we are exploring topics related to autoimmune diseases, to help patients and their loved ones understand and manage their condition. Today were going to focus on autoimmune hepatitis. We welcome Dr. Jama Darling who is an Assistant Professor of Medicine in our Division of Gastroenterology and Hepatology. Dr. Darling specializes in the treatment of hepatitis and other chronic liver diseases. Welcome, Jama.
Jama Darling, MD: Thank you.