Hepatitis refers to inflammation of the liver. Hepatitis is most commonly caused by viruses; however, drugs, alcohol, and fat can also cause hepatitis. There are different types of viral hepatitis, including hepatitis A, B, C—the most common types—and hepatitis D and E, which are rare in the U.S. Viral hepatitis is the leading cause of liver cancer as well as the number one reason for liver transplantation.
At the Viral Hepatitis Program, part of the University of Michigan’s Hepatology Program, we provide the latest diagnostic and treatment options to our patients as well as ready access to investigational therapies for hepatitis B and C through clinical trials. For patients receiving treatment with FDA-approved medications, we have experienced physician assistants and nurse practitioners dedicated to assisting patients with access to medications, including monitoring of response, and management of side effects.
Who’s at Risk for Viral Hepatitis?
Hepatitis A and hepatitis E viruses are excreted in stool and are transmitted through contaminated food or water. Risk factors for hepatitis A and E include eating undercooked food or drinking contaminated water and traveling to countries where there is poor sanitation.
Hepatitis B and hepatitis C viruses are transmitted through exposure to blood, secretions, and wounds of persons who are infected. Risk factors for hepatitis B and C include sharing contaminated needles and syringes, having unprotected sex or multiple sex partners, and being born to a mother who is infected.
Hepatitis D virus can only be transmitted in the presence of hepatitis B virus.
Viral Hepatitis Symptoms
Different types of viral hepatitis can have the same symptoms. Hepatitis may be acute (newly onset, lasting less than 6 months) or chronic (virus persists more than 6 months). Hepatitis B, C, and D can become chronic. Chronic hepatitis B, C, and D can potentially progress to cirrhosis and liver cancer.
During acute infection, there may be no symptoms or one or more of the following symptoms:
- Low grade fever
- Feeling tired
- Poor appetite
- Stomach pain
- Jaundice (yellowing of eyes and skin)
During chronic infection, there are often no symptoms until the liver is badly damaged. Common symptoms include:
- Feeling tired
- Discomfort or an ache over the liver
Viral Hepatitis Diagnosis
The diagnosis of viral hepatitis begins with blood tests for liver enzymes, such as an aspartate aminotransferase (AST) test and/or an alanine aminotransferase (ALT) test. High levels of these enzymes indicate there is liver injury. AST and ALT levels tend to be very high during acute infection and may only be slightly increased or even normal in patients with chronic infection.
Additional blood tests are needed to find out which virus is causing the hepatitis. For patients with hepatitis B or C, tests are performed to find out how active the virus is and whether antiviral treatment is needed. For patients with hepatitis C, a test is given to help in selecting which drugs to use and how long treatment should be given.
A scan of the liver, using ultrasound or other imaging method, may be needed to see if liver damage has progressed to an advanced stage, such as cirrhosis.
Fibroscan, also called transient elastography, is one of the non-invasive methods for assessing stiffness of the liver that correlated to the scarring in the liver. This is an outpatient procedure and can be performed at the time of your clinic visit. Sometimes, a liver biopsy—removing tissue for examination under a microscope by a needle inserted into the liver—is performed to find out how much damage there is in the liver. This is an outpatient procedure and can be done using only local anesthetic.
Viral Hepatitis Treatment
Supportive care—nutrition, hydration, and symptom control—is provided for those with acute infection. Antiviral therapy (medication) is usually not necessary.
Antiviral treatment may be recommended for chronic infection with hepatitis B, C, or D if there is evidence of active infection and liver damage. Not all patients with chronic hepatitis B, C, or D need to be on antiviral treatment. Some patients may be monitored initially with treatment started later if the virus becomes more severe or if there is liver damage.
Direct-acting antivirals for treatment of hepatitis C are new drugs in clinical trials. Many of these trials involve combinations of oral drugs and the course of treatment may be as short as 12 weeks. Investigators at the University of Michigan were the first in the world to publish results of a study showing that combination of oral drugs only can lead to a “cure” for hepatitis C.
Beginning March 1, 2016, Medicaid recipients in Michigan will have coverage for new medications to treat hepatitis C.
Patients at the University of Michigan may take part in a wide range of clinical trials testing new ways of using approved drugs or investigational new drugs. For a list of active clinical trials, visit the gastroenterology clinical studies page for links to digestive and liver health studies.
Other Information About Digestive and Liver Health
To see related medical services we offer, visit our Digestive and Liver Health overview page.
Make an Appointment
To make an appointment to discuss concerns about or treatment for hepatitis, call our Viral Hepatology program at toll-free 844-233-0433.