Blood-Borne Hepatitis

Blood-borne hepatitis: HBV, HCV, and HDV

Hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) are all transmitted through exposure to infected blood. Exposure to HBV and HCV can also occur from sexual contact with infectious seminal and vaginal secretions. These forms of viral hepatitis cause signs and symptoms similar to influenza, including decreased appetite, nausea, vomiting, fever weakness, malaise, muscle aches, and jaundice. The severity of symptoms varies widely, ranging from mild to debilitating.

Hepatitis B (HBV) is the most common form of blood-borne hepatitis and an important healthcare occupational pathogen. HBV is 50-100 times more infectious than the HIV virus which produces AIDS.* HBV has been detected in blood and blood products, seminal fluid, vaginal secretions, breast milk, tears, and saliva. HBV vaccination, standard precautions and appropriate post-exposure management are have been demonstrated to significantly reduce the risk of occupational transmission.

The onset of HBV is usually gradual and the majority of infected persons recover within six months. However, 5 to 10% of patients with HBV infection develop chronic hepatitis or become carriers. Chronic hepatitis increases the risk of developing cirrhosis, primary hepatocellular carcinoma and fulminant hepatitis, which is almost always fatal. Chronic hepatitis is an inflammatory reaction of the liver that lasts for more than 6 months. Fulminant hepatic failure is massive liver cell death within 2 months of the development of acute hepatitis. Death occurs in 80% of patients with fulminant hepatic failure due to gastrointestinal bleeding, sepsis, brainstem compression from cerebral edema, or multisystem failure. People with HBV can also become carriers of the virus and can transmit it to others. Approximately 1.2 million Americans are chronic carriers of HBV. Persons in high risk groups, such as health care and hemodialysis workers, homosexually active men, IV drug users, household and sexual contacts of HBV carriers, IV drug users, refugees from endemic areas, prison inmates, and infants born to women who are HBV carriers, should receive HBV vaccine, which provides active immunity for up to 5 years. The Occupational Safety and Health Administration requires that health care facilities offer the HBV vaccine to those employees with jobs that require exposure to blood, blood products, or other potentially infectious materials.

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Chronic HBV infection increases an individual's risk of developing cirrhosis and primary liver cancer.

TRUE or FALSE

New drugs are being used to treat chronic HBV. Please visit this site and look for the answer to this question.

Please name two drugs that are being used to treat HBV.

Hint: One of the drugs is L_________ and the other drug (A______) is used for people who are resistant to the first drug.

Hepatitis C was identified in 1989. Prior to that time, because it could not be classified as either hepatitis A or B, it was referred to as non-A, non-B hepatitis. HCV is usually mild in its early stages and is rarely recognized until it has caused significant liver damage. HCV is a significant public health problem, both in the U.S. and worldwide. HCV, in combination with HBV, now accounts for 75% of all cases of liver disease around the world, and HCV infection is the leading reason for liver transplantation in the United States.

HCV is difficult for the immune system to combat. Unlike most other forms of hepatitis, more than 80% of patients infected with HCV develop a chronic infection that leads to serious and potentially fatal liver disease. The cycle of disease from infection to potential liver failure can take 20 or more years. For more than six months following initial infection, the disease is virtually undetectable. Many cases of HCV are undiagnosed because the symptoms are similar to flu-like illness. People who have HCV are often identified when they have elevated liver enzymes during a routine blood test or because a positive HCV antibody is found when they donate blood. At present, there is no vaccine to prevent HCV.

Most patients with HCV contracted the disease through blood transfusions in the 1970s and 1980s. Improved blood testing since 1993 has reduced the risk to less than 1%; however, anyone who had a blood transfusion prior to that time is at risk for having been infected. Other risk factors for contracting HCV include:

Tattooing, acupuncture and other body piercing practices using non-sterile means
Needlestick injuries
Blood spills
Exposed non intact skin
Contaminated medical equipment
IV drug use
Heterosexual or homosexual activity with multiple sex partners
Day to day contact with an infected household member

Almost any direct or indirect exposure to infected blood can transmit HCV. In about 10% of cases, no specific risk factor can be identified. It extremely important for the patient with HCV to prevent stressing an already damaged liver. It is especially important to avoid any form of alcohol, as studies have shown that alcohol significantly increases liver damage in HCV patients. Patients with HCV may also consult with their physicians and pharmacists to eliminate many over-the-counter and/or prescription drugs that can increase liver damage.

Patients with HCV often struggle with the social stigma of having hepatitis. Traditionally, hepatitis has been seen as a disease of alcoholics and the poor. Because of the long course of HCV infection, patients may have long life expectancies, and with appropriate treatment, may recover from the HCV infection.

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Patients who have HCV should abstain from alcohol.

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The hepatitis D (HDV) virus is sometimes referred to as incomplete or defective because it requires the host be infected with HBV before it to replicate. HDV is obliged to use enzymes produced by HBV to reproduce.

Patients who have HBV-HDV co-infection frequently have severe disease, which may progress to fulminant hepatitis. Interferon may be beneficial in approximately 50% of patients with HBV-HDV. HDV is primarily seen in IV drug users, people who have received multiple blood transfusions and people from South America, Africa, the Middle East, and Italy, where the disease is endemic.

Blood tests are used to diagnose HAV, HBV, HCV, and HDV. Because these tests detect specific antibodies, they can determine whether a patient is acutely ill, has chronic infection, or is recovering from the disease. Treatment of acute hepatitis is primarily symptomatic and includes interventions to help relieve muscle pain, gastrointestinal distress, and pruritis. Malnourished or severely anorexic patients may need vitamin supplements. A low fat, easily digested diet is useful for patients with diarrhea, nausea, and vomiting. Patients recovering from acute hepatitis should avoid strenuous physical exertion and hepatotoxic agents such as acetaminophen and alcohol. The chronic form of HBV is treated with corticosteroids, interferon, and drugs such as acyclovir. Chronic HCV is treated with interferon or a combination of interferon and rabavirin.

There are a number of health care practices that individuals can follow to avoid developing HBV, HCV, and HDV. Important prevention measures include practicing safe sex, cleaning up blood spills promptly with bleach, and avoiding sharing razors, toothbrushes, nail clippers, or needles. When getting a manicure, a tattoo, or having any body part pierced it important to ensure that the instruments used are sterile.