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What’s the Difference Between Hepatitis A, B and C?

What’s the Difference Between Hepatitis A, B and C?

One usually goes away on its own. One can cost $26,000 to treat. Which is which?

Your liver, the largest organ in your body, plays an outsized role in keeping you healthy. It helps your body digest food, filters toxins, stores some nutrients and helps regulate certain hormones and cholesterol. It also acts as a chemistry lab, transforming substances—like proteins—into compounds your body needs to function.

But when hepatitis strikes, all these vital functions slow down.

Hepatitis is the general term for inflammation of the liver. “Hepatitis occurs for a variety of reasons, including infections, medications, alcohol or drug use,” says Elaine A. Leigh, DNP, RN, FNP-BC, at Mercy Health Hepatitis C Clinic in Muskegon, Michigan.

Three different viruses cause the three most common kinds of infectious hepatitis in the US; they're known by the letters A, B and C.

Acute hepatitis symptoms
All three hepatitis viruses cause acute infection at first; in the cases of hepatitis B and C, it may eventually become chronic. There are often no symptoms in the beginning, especially with hepatitis B and C.

If you do have symptoms of an acute infection, they will be similar, no matter which hepatitis virus you have. You may develop a fever, a sick-all-over feeling, appetite loss, diarrhea, vomiting, stomach pain, dark-colored urine and jaundice (when your skin and the whites of your eyes yellow). These can be mild to severe.

Three different diseases, three different treatments
Hepatitis A is caused by the hepatitis A virus (HAV). You can acquire it when you eat food or drink water contaminated with the feces of an infected person. You can also contract it through sexual contact or other very close contact with someone who has the disease. Risks for hepatitis A include poor sanitation, an unsafe water supply and poor hygiene. A vaccine, which American children receive in two doses starting between 12 and 23 months, can prevent hepatitis A.

Unlike the two other forms of hepatitis, hepatitis A doesn’t cause chronic disease. The virus usually clears in several weeks or a few months without treatment, and rarely is it deadly. In less than 1 percent of cases, people with hepatitis A develop fulminant hepatitis, a frequently fatal syndrome in which the liver fails completely. Often, those people are older or have other chronic liver infections.

Hepatitis B is caused by the hepatitis B virus (HBV). It begins as an acute infection, often showing no symptoms. In about 10 percent of cases, the infection is chronic—meaning it lasts more than six months—and continues to attack the liver silently. It may become life-threatening and lead to cirrhosis or cancer.

You acquire hepatitis B through blood—often, via shared needles—or through the other body fluids of an infected person. Official guidelines from the Centers for Disease Control and Prevention (CDC) call for all babies to be fully vaccinated by 6 months old.

There is no treatment for acute hepatitis B, but you will need treatment if it becomes chronic. “[The majority] of people exposed to the virus can spontaneously clear it on their own, meaning their bodies are able to successfully beat the disease without medication,” says Leigh. "Once you have the virus for at least six months, your doctor will treat you based on your individual condition." She notes that treatment is started much earlier for people of Asian descent, since they are more likely to develop liver cancer.

Medication for hepatitis B is often taken for the rest of a person’s life.

Hepatitis C is caused by the hepatitis C virus (HCV). Like hepatitis B, it begins as an acute, often symptomless infection, and can progress to chronic hepatitis—a serious, life-long illness. You can contract the disease from the blood of an infected person, through unsafe injection of recreational drugs or via intranasal drug use (sharing straws to snort drugs). Blood transfusions before 1992—when blood wasn’t screened—were also responsible for transmitting hepatitis C, says Leigh.

Some of those with hepatitis C are able to clear the virus within six months of infection, without being treated. Still, the CDC says 75 to 85 percent of people will develop a chronic HCV infection. They have a 5 to 20 percent risk for developing cirrhosis of the liver within 20 to 30 years.

Hep C screening is recommended for all people between the ages of 18 and 79 years old, according to the U.S. Preventive Services Task Force.

Chronic hepatitis C treatment has vastly improved over the years—and the cost is dropping. In August 2017, the FDA approved a new drug called Mavyret (glecaprevir and pibrentasvir) which effectively cures most chronic hepatitis C patients. Mavyret costs about $26,000 for the typical 8-week course treatment, whereas some earlier hepatitis C medications approached $100,000.

How to slash your hepatitis risk
You can protect yourself from hepatitis A and B by making sure your vaccines are up-to-date. There is no vaccine for hepatitis C as of yet. To safeguard against contracting the disease, avoid unprotected sex and don’t share needles; use gloves and wash your hands carefully if you’re in contact with blood or fluids from an infected person.

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