Hepatitis — viral liver inflammation

Hepatitis means inflammation of the liver — viral hepatitis (A, B, C, D, E) is the most common cause worldwide. Other causes include alcohol, fatty liver, autoimmune disease, and medicines.

This guide focuses on hepatitis A, B, and C — the types most relevant in the UK.

Hepatitis A

Transmission: faecal-oral — contaminated food/water, poor hygiene, sexual contact (rimming).

Course:

  • acute illness — jaundice, malaise — weeks
  • does not become chronic
  • ** lifelong immunity** after infection

Prevention: vaccine — travel to endemic regions, men who have sex with men, chronic liver disease.

Treatment: supportive — rest, fluids — no specific antiviral.

Hepatitis B

Transmission: blood and body fluids — sexual contact, sharing needles, mother to baby at birth, healthcare exposure (rare in UK).

Course:

  • acute — adults often clear virus (95%)
  • chronic — 5 to 10% adults, 90% infants infected at birth — long-term infection

Chronic HBV risks:

  • cirrhosis
  • hepatocellular carcinoma
  • requires lifelong monitoring and often antiviral suppression

Prevention: UK infant vaccination programme — highly effective.

Treatment chronic: tenofovir, entecavir — suppress viral replication — reduce cancer risk.

Hepatitis C

Transmission: predominantly blood:

  • injecting drug use — past or present — test everyone
  • blood products before September 1991 (UK)
  • unsterile medical procedures abroad
  • tattoo/piercing with unsterile equipment
  • needle stick
  • vertical transmission — ~5%

Sexual transmission: low except HIV-positive MSM.

Course:

  • acute — often asymptomatic
  • chronic in ~75% if not cleared spontaneously
  • decades of silent damage — cirrhosis, cancer

Revolution: direct-acting antivirals (DAAs) — 8 to 12 weeks oral tablets — >95% cure (SVR12) — minimal side effects — NHS treatment for all diagnosed.

England elimination strategy — test and treat at-risk groups.

Symptoms — all types

Acute:

  • fatigue
  • nausea
  • jaundice
  • dark urine, pale stools
  • right upper pain

Chronic B/C:

  • often none until cirrhosis — ascites, variceal bleed, encephalopathy

Testing

Blood tests:

  • hepatitis B surface antigen (HBsAg) — current infection
  • anti-HBc, anti-HBs — past infection or immunity
  • hepatitis C antibody → HCV RNA PCR if positive
  • LFTs, fibrosis assessment if chronic

Anyone with risk history — one-off HCV test — NHS campaign.

Hepatitis C treatment today

Pan-genotypic DAAs — e.g. sofosbuvir/velpatasvir — 8 to 12 weeks:

  • cure >95%
  • few contraindications
  • check drug interactions — amiodarone caution

Retest 12 weeks post-treatment — SVR = cure.

Old interferon injections — obsolete for most.

Co-infection and prevention

  • HIV/HCV co-infection — treat both — see HIV guide
  • alcohol abstinence if any hepatitis — accelerates damage
  • vaccinate against A and B if chronic liver disease

When to worry

Acute liver failure — rare — confusion, bleeding, profound jaundice — 999.

Chronic disease — surveillance for cancer with ultrasound and AFP if cirrhosis.

Hepatitis C is now curable in weeks — legacy of undiagnosed chronic infection remains — if you ever shared a needle, get tested once.

Common questions about hepatitis

What are the symptoms of hepatitis?
Acute phase — fatigue, nausea, loss of appetite, upper right abdominal pain, jaundice, dark urine, pale stools, fever. Many chronic hepatitis B and C cases have no symptoms until liver damage advanced — reason for testing at-risk groups.
How is hepatitis C treated?
Direct-acting antiviral (DAA) tablets — 8 to 12 weeks — cure rate over 95% with few side effects. Pan-genotypic regimens (e.g. sofosbuvir/velpatasvir combinations) on NHS — specialist or GP depending on local pathway. Retest blood confirms cure (sustained virological response).
Is hepatitis B curable?
Most adults clear acute hepatitis B spontaneously. Chronic hepatitis B suppresses with long-term antiviral tablets (tenofovir, entecavir) — controls virus and prevents cirrhosis — functional cure possible in some. Vaccine prevents infection.
How do you catch hepatitis C?
Blood-to-blood contact — shared needles (injecting drug use highest UK risk), unsterile tattoo/piercing historically, blood transfusion before 1991 UK screening, needle stick injury, mother to baby (lower rate than HIV). Sexual transmission uncommon except MSM with HIV co-infection.
Who should get the hepatitis B vaccine?
All UK infants in routine schedule; also healthcare workers, people with chronic kidney disease on dialysis, partners of hepatitis B carriers, men who have sex with men, and some occupational exposures. Hepatitis A vaccine for travel to endemic areas and risk groups.

Sources

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