What is hepatitis, and what are the types of hepatotropic viruses?
Hepatitis is an inflammation of the liver most often caused by a hepatotropic virus. If left undiagnosed and untreated, it can progress to a chronic form, cirrhosis, or hepatocellular carcinoma. Arnaud, Ph.D. in Pharmacy, emphasizes: any suspicion of hepatitis warrants immediate serological testing. See our liver disorders hub and our jaundice page for visual signs.
- Hepatitis A (HAV): fecal-oral transmission (contaminated water/food, raw shellfish) — outbreaks in areas with poor sanitary conditions and among travelers — mild, self-limiting acute form (recovery in 1–3 months) — never becomes chronic — vaccine available (2 doses, >95% protection)
- Hepatitis B (HBV): transmission via blood, sexual contact, and vertical transmission (mother → child) — 250 million chronic carriers worldwide — risk of chronicity: 90% if infected as a newborn, 5% if infected as an adult — vaccination mandatory for infants in France since 2018
- Hepatitis C (HCV): blood-borne transmission (sharing needles, non-sterile tattoos, blood transfusions prior to 1992) — 170,000 chronic carriers in France — asymptomatic for 20–30 years in 80% of cases — curable in >95% of cases with DAAs (direct-acting antivirals, 8–12 weeks)
- Hepatitis D (HDV): a satellite virus of HBV (co-infection or superinfection) — occurs only in HBsAg carriers — severe forms — prevented by HBV vaccination
- Hepatitis E (HEV): fecal-oral transmission (undercooked pork or wild boar meat in Europe) — mild acute course in immunocompetent individuals — severe in pregnant women (mortality rate 20–25%) and immunocompromised individuals — no vaccine available in France
Symptoms, diagnosis, and progression to chronicity
- Acute phase: fatigue, fever, loss of appetite, nausea, right upper quadrant pain → jaundice + dark urine + pale stools — very elevated transaminases (ALAT > 10× normal)
- Silent hepatitis C: 80% of cases are asymptomatic — incidentally discovered during routine testing or systematic screening — screening recommended in France (one HCV serology test in a lifetime for all adults aged 18–75)
- Progression to chronic infection: HBV → 5–10% of adults, 90% of infants — HCV → 80% — HDV → 90% — long-term risk: cirrhosis + hepatocellular carcinoma
- Serological diagnosis: HBsAg + anti-HBV + anti-HAV IgM + HCV RNA (PCR) + anti-HEV IgM — liver function tests (ASAT/ALAT/GGT) + ultrasound + Fibroscan (fibrosis assessment)
- Emergencies: fulminant hepatitis (jaundice + encephalopathy + PT < 50%) → urgent transplantation — see our page on liver failure
Antiviral Treatments and Supportive Care
- Hepatitis C — Direct-acting antivirals (DAAs): sofosbuvir + ledipasvir/velpatasvir — cure rate > 95% — 8–12 weeks — 100% covered in France — routine screening = the best prevention
- Chronic hepatitis B: tenofovir or entecavir (antivirals) — control of viral replication without cure in most cases — lifelong treatment — monitoring every six months
- Hepatitis A and E: symptomatic treatment — rest, hydration, light diet — low-dose acetaminophen (max 2 g/day) if experiencing pain — avoid all hepatotoxic medications
- Milk thistle (silymarin): hepatoprotective agent to support chronic hepatitis B and C — protects hepatocytes against oxidative stress — a supplement to antiviral treatment, never a substitute — see our page on hepatoprotective agents
- Frequent vitamin D3 deficiency in chronic hepatitis — supplementation of 1,000–2,000 IU/day — impacts hepatic immunity and fibrosis
Vaccination, Prevention, and Nutrition
- HAV vaccination: 2 doses — recommended for travelers, healthcare professionals, children in group settings, and people with liver disease — >95% protection starting on day 15
- HAV vaccination: 3 doses (0–1–6-month schedule) — mandatory for infants; recommended for healthcare workers, sexual partners of HBsAg-positive individuals, and immunocompromised patients — anti-HBs antibody testing (titer > 10 mIU/mL = protection)
- HCV Prevention: single-use syringes, sterile tattooing/piercing equipment, condoms if you have multiple sexual partners, one-time serological testing recommended for all adults aged 18–75
- Diet during hepatitis: alcohol strictly prohibited (exacerbates cytolysis) — high-protein diet: 1–1.2 g/kg/day (to support hepatocyte regeneration) — easily digestible foods — limit saturated fats
- Follow-up after hepatitis C cure: HCV RNA testing at 12 weeks post-treatment + liver function tests at 6 months — if pre-existing cirrhosis → AFP monitoring + ultrasound every 6 months (residual risk of HCC even after cure)
