Viral Hepatitis

Hepatitis A

Hepatitis A (HAV) is usually not a serious illness. It is prevalent in developing countries, especially those with overcrowding and poor sanitation, in men who have sex with men, and injecting drug users. HAV does not lead to chronic disease; it produces acute symptoms that may persist for several weeks. Only 1% of people with HAV experience fulminant, or acute, infection and require a liver transplant.

Causes and Risk Factors
HAV is transmitted primarily through feces-contaminated food and water, direct oral exposure to the virus (e.g., from a finger that has contacted infected feces), and sexual contact. In 1998, an outbreak in the United States occurred when school children in the Midwest ate imported strawberries that had been contaminated during harvest. Specific risk factors include the following:

• Eating imported fruits, vegetables, and dairy products
• Eating raw or undercooked shellfish
• Kissing (when infection is present)
• Poor hygiene
• Using contaminated intravenous needles
• Unprotected sex (especially anal sex)

Signs and Symptoms
Some people, children particularly, experience no symptoms of HAV. Those that do usually develop signs and symptoms within a few weeks of infection:

• Dark urine
• Diminished appetite
• Fatigue
• Inflammation of the liver
• Jaundice (yellowing of skin, eyes, and mucous due to bile pigment deposition and bilirubin enzyme release)
• Light-colored feces
• Loss of taste for coffee, alcohol, cigarettes
• Mild fever
• Nausea

Diagnosis
Hepatitis may be detected by testing the liver for elevated levels of transaminase enzymes, which catalyze amino acids. Levels increase when the liver becomes inflamed. The immunoglobulin M (IgM) antibody to hepatitis A may be found with a blood test for up to a year following infection. Most people are no longer infectious by the time they are diagnosed.

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Treatment
There is no specific treatment for HAV, which is a self-limiting virus. Immediate treatment with immune globulins (IG; antibodies normally present in blood) may be effective for those who are not vaccinated. People usually recover within a few weeks, experience no lingering symptoms, and develop immunity to the virus. Staying hydrated and avoiding alcohol and other toxins that tax the liver, including nonsteroidal anti-inflammatory drugs like Tylenol®, is important during recovery. Rehydration may be done intravenously (IV) and nausea and vomiting can be controlled with medication.

Prevention
Hygiene, careful food preparation, safer sex, and avoiding used needles, can prevent the spread of HAV. HAV vaccination, which has been available for 6 years, is 95% effective and has few side effects. It is given twice, 6 to 12 months apart. All men who have sex with men and people planning to travel to underdeveloped countries are advised to get an HAV vaccination.

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