What is Non-A, Non-B Hepatitis and Hepatitis C?

Hepatitis means inflammation of the liver. One frequent cause is viruses. The most common hepatitis viruses are hepatitis A, hepatitis B, and hepatitis C. Previously, viral hepatitis that was not caused by the type A or type B virus was called "non-A, non-B hepatitis." Recently three more viruses have been identified that cause some of these non-A, non-B infections. These new viruses are hepatitis C, D, or delta, and E.

The hepatitis C virus (HCV) is thought to cause 95% of non-A, non-B hepatitis infections in people who have had blood transfusions. In addition, hepatitis C probably causes 50% of cases of sporadic non-A, non-B hepatitis.

With viral infection, the liver becomes inflamed and usually becomes tender and swollen. Patches of liver tissue may be destroyed.

The most important feature of hepatitis C is the frequency with which people develop chronic (ongoing) liver disease. Even mild cases tend to get worse over time, often resulting in cirrhosis of the liver. Research continues to determine whether hepatitis C has the same risk of liver cancer as hepatitis B.

How does it occur?

Non-A, non-B hepatitis and hepatitis C are usually spread through blood transfusions. How sporadic cases occur, which are not associated with transfusions, is unclear. Sexual transmission is suspected.

Non-A, non-B hepatitis and hepatitis C can be spread by people who do not have an active infection. They are called asymptomatic carriers.

What are the symptoms?

The symptoms of hepatitis C and non-A, non-B hepatitis are similar to the symptoms of other forms of viral hepatitis. Symptoms may appear 2 weeks to 6 months after you are infected. Some people develop a chronic form of the disease without any obvious symptoms, even though damage to the liver may be occurring.

The disease usually begins with typical symptoms of infection:

• loss of appetite
• weight loss
• fever
• general achiness
• fatigue

Other early symptoms may include:

• itching hives
• pain in some of the joints
• in smokers, a loss of taste for cigarettes

The following symptoms may follow after several days:

• nausea and vomiting
• foul breath and bitter taste in the mouth
• dark urine
• yellowish skin and eyes (jaundice)
• pain just below the ribs on the right side, especially when pressure is applied
• bowel movements that are whitish or light yellow and may be looser than normal
  

The symptoms of chronic hepatitis may be persistent fatigue, weakness, loss of appetite, as well as some of the other symptoms of hepatitis. Often chronic hepatitis has no symptoms.

How is it diagnosed?

Your medical history including onset and progression of symptoms is the important first step in diagnosis. Especially important is your history of hepatitis risk factors such as transfusions.

On physical exam, the doctor may find that the liver is enlarged and tender when pressed. He or she may use the following lab tests:

• blood tests
• analysis of a urine specimen
• analysis of a stool specimen

Or your exam may be entirely normal with hepatitis C.

If hepatitis C is suspected it can now be identified by blood test. Hepatitis C is often found incidentally at routine screening when liver function tests are abnormal.

To diagnose chronic hepatitis, the doctor may order a liver biopsy, a procedure in which a small amount of tissue is removed for examination. This is done through the skin after local anesthesia is injected.

How is it treated?

The doctor will recommend getting rest, eating a nutritious diet, and avoiding alcohol and certain medications for at least 6 months. Hospitalization isn't usually necessary.

In more serious cases (for instance, if you become severely dehydrated), you may need to be hospitalized.

Alpha interferon can be used to treat non-A, non-B hepatitis, and chronic hepatitis C. Adequate nourishment and avoiding overexertion and alcohol are also important in treating chronic hepatitis. To reduce inflammation, the doctor may prescribe steroids.

Regular examinations are very important and may continue at regular intervals for months to years.

How long will the effects last?

Symptoms may last from 1 to 6 weeks and are usually followed by complete recovery. Relapse is common, however, and can be triggered by drinking too much alcohol or exerting yourself before you are fully recovered. It may also be caused by another infection. Relapses are usually milder than the initial infection and respond well to rest.

After having viral hepatitis, a third to half of patients develop chronic hepatitis. As many as 35% develop chronic liver disease, including cirrhosis. The doctor may check your blood regularly for signs of chronic liver disease.

How can I take care of myself?

Avoid taking drugs that are metabolized in the liver. Ask the doctor which drugs these are.

Rest in bed until your fever is gone, your urine returns to its normal color, and your jaundice disappears. Ask the doctor how much bedrest is necessary and when you should resume normal activity.

As your symptoms improve, you may gradually increase your level of activity. Avoid strenuous activities for several months.

Eat small, balanced meals, even when you feel nauseous. Some foods may not appeal to you, especially in the early stages of the disease. Lightly carbonated soft drinks, juices, and hard candy may help reduce nausea.

Follow the doctor's instructions for taking medicines to relieve your symptoms.

Call the doctor if any of the following occurs:

• Your appetite continues to decrease.
• You have worsening drowsiness, confusion, or irritability.
• You have vomiting, diarrhea, or abdominal pain.
• Your jaundice worsens.
• You have a rash or your skin itches.
  

What can be done to help prevent spreading non-A, non-B?

• Use good health habits. Bathe frequently and take special care to wash your hands thoroughly with soap and very warm water after using the bathroom and before eating or preparing food.
• Clean bloodstains with a disinfectant.
• Avoid sharing needles, razor blades, and toothbrushes with others.
• Avoid donating blood if you have hepatitis or may be a carrier.

At this time there is no immunization for hepatitis C.