If you're like most people, you probably don't give your liver a second thought. But it's a pretty essential organ, tirelessly breaking down fats, scrubbing your blood of alcohol and other toxins, recycling blood cells, and more. That's why anything that messes with it can be kind of scary. And one liver condition in particular is a big problem.
An estimated 4.4 million people in the United States and nearly 400 million people worldwide have chronic viral hepatitis, which is caused by a bunch of different viruses that can inflame the liver and affect its ability to function. Hepatitis is the eighth largest killer in the world and just one type, hepatitis C, kills more Americans than HIV. Since today is World Hepatitis Day, here are a few more facts to clue you in on this condition:
Not all forms are related to risky habits
You've probably heard that actress Pamela Anderson has hepatitis C, which she says she contracted after sharing a tattoo needle with former husband Tommy Lee. But not all types of the virus are spread through direct exchange of bodily fluids. Of the five different types of hepatitis, some viruses spread through contaminated food or water (more on that below), while type B travels through blood and body fluids, and type C through blood alone. In many cases, the liver can fight the infection on its own, but some can turn into chronic infections with long-term health consequences. As of now, vaccines only exist for types A (which causes food poisoning, but goes away) and B.
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Most people don't realize they have it
Sometimes hepatitis can be hard to detect because it starts out with mild, flu-like symptoms including fever, fatigue, and body aches. (Other symptoms include dark urine and vomiting.) It can take weeks or months before you see things like skin rashes, loss of appetite, weight loss, and the trademark yellowing of the skin and eyes known as jaundice. But for some people, these symptoms may take years to develop—or they won't show up at all, particularly when it comes to hepatitis C, says Douglas Dieterich, MD, a professor of medicine and a specialist in liver diseases at the Icahn School of Medicine at Mount Sinai. Up to 3 in 4 people with hepatitis C don't know they have it, according to the Centers for Disease Control and Prevention. "That could be because with the acute infections [like hepatitis A], people may have a larger immune response that causes inflammation which would bring the symptoms out," Dr. Dieterich says. "Whereas the immune response with a chronic infection might be smaller so you don't see many symptoms."
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Germy water and food are risky
Hepatitis A and E are both considered acute viral diseases: that is, most people recover completely without long-term damage. However, the infections can be more serious in people who already have liver diseases. Both viruses are transmitted by what's known as the fecal-oral route: that is, eating food or drinking water that's been contaminated by the feces of someone who has the virus. This is especially common in places with contaminated food or water or sites with flooding. While hepatitis E is rare in the U.S., Americans aren't in the clear when it comes to either infection. For one, if you plan to travel to countries with poor sanitation, you'll want to make sure you practice good hygiene, including washing your hands after bathroom trips, drinking purified water, and avoiding uncooked foods—specifically meat from pigs, boar, and deer. These animals can carry the hep E virus, and the CDC warns that it's possible to get the virus as the result of eating undercooked meat from infected animals. It's best to be cautious when cooking: The FDA says to cook pork until it reaches an internal temperature of 145 degrees as measured by a food thermometer.
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Some forms can lead to cancer
Unless treated properly, inflammation from chronic hepatitis can lead to cell damage and, eventually, liver cancer. The CDC reported in 2010 that a type of liver cancer called hepatocellular carcinoma (HCC) was on the rise and that chronic hepatitis B and C infections accounted for an estimated 78% of HCC cases worldwide. "Most of the patients we see with liver cancer, the number one reason is chronic hepatitis C followed by chronic hepatitis B," Dr. Dieterich says. And if you have a family history of liver cancer or your infection has caused internal, irreversible scarring from a condition called cirrhosis, your chances of developing cancer are even greater. Since it can be hard to tell if you even have hepatitis, it's a good idea to get tested if you think there's a chance you've been exposed, especially if you've used injected drugs, been on dialysis, had a blood transfusion before 1992, or were born between 1945 and 1965. Yes, baby boomers are the most likely group to develop hepatitis C, according to a 2013 report.
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Drinking alcohol can make it worse
While certain medications can help people manage hepatitis, lifestyle choices can affect how it progresses. For one, patients need to make sure they're not drinking too much. "In both types B and C, alcohol definitely makes the scarring of the liver worse and progress faster," Dr. Dieterich says. A study published in Alimentary Pharmacology & Therapeutics found that patients with chronic hepatitis C who had three or more drinks a day were five times more likely to die than heavy drinkers without the disease. Even those who had a moderate two drinks a day were still twice as likely to die. That's why the CDC recommends chronic hepatitis patients receive counseling about alcohol use. And shedding some extra pounds isn't a bad idea either, as a build up of fat in the liver can also lead to cirrhosis, Dr. Dieterich says.
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Pregnant women should be tested for one type
The most common cause of hepatitis B transmission globally is mother to infant, Dr. Dieterich says. So pregnant women should be screened for the virus when they receive prenatal care, according to the CDC. While infants born to mothers with hep B can be vaccinated right away and receive antibodies to help fight the infection, both can fail to prevent transmission up to 10% of the time if the mother already has high levels of the virus in her blood, he says. If you've had the hepatitis B vaccine, you should be protected from catching the virus and later passing it on to your child. But if you haven't had it yet and want to get pregnant, now's a good time to make the appointment.
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Two of the diseases are linked
People who already have chronic hepatitis B are at risk for becoming infected with a second virus, hepatitis D, also called delta hepatitis. That can be even more difficult to treat as delta does not respond well to the available medications. "It makes hepatitis B worse by far even when you treat the original condition," Dr. Dieterich says. Some patients who contract it can experience a simultaneous infection with both viruses—not good if you want to avoid serious complications like liver failure. The best way to protect yourself is to get the hepatitis B vaccine, which is up to 95% effective at preventing infections, according to the World Health Organization. The CDC recommends the vaccine for all sexually active people who are not in long-term relationships.
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Treatments have evolved
In the past, Interferon has been the drug of choice to treat chronic hepatitis C, but the medication often has uncomfortable side effects, like nausea, diarrhea, fatigue, and muscle aches. But thanks to two recent FDA drug approvals—Sovaldi and Olysio—hepatitis patients have more reason to be optimistic about being able to eliminate the virus. While the pills can be used along with Interferon, most of the time they can be taken on their own. A recent trial treated patients using both Sovaldi and Olysio and found a 94% cure rate in chronic hepatitis C patients. "We can treat completely without interferon now," Dr. Dieterich says. "And we have so many new drugs coming to help cure hepatitis C."