Hepatitis A, B, and C Treatment

What are Hepatitis A, B, and C?

Hepatitis is an inflammation of the liver which can be acute or chronic leading to fibrosis, cirrhosis, or cancer.

Hepatitis viruses are the most common causes of hepatitis. Hepatitis A, B, and C are diseases of concern in Singapore and treated by specialists called gastroenterologists.

What are the symptoms of Hepatitis A, B, and C?

There may be no symptoms in the early stages of infection. Later, the symptoms may include nausea, fatigue, poor appetite, abdominal pain, a mild fever, or jaundice.

In patients with chronic hepatitis B and C infection, there may be long periods where they are no symptoms. By the time there are symptoms, the liver may already be damaged.

What causes Hepatitis A, B, and C?

Hepatitis A infection is typically caused by ingestion of contaminated food or water. If food is touched by an infected person who did not wash his hands after using the bathroom, small amount of infected stool could transfer to the food. Raw shellfish, fruits, vegetables, and undercooked foods have been blamed for outbreaks. In many cases, these infections are mild, with most people making a full recovery.

Hepatitis B and C usually occur as a result of contact with infected body fluids. The virus can be spread through unprotected sex or by sharing an infected person’s needles, razors, or toothbrush. An infected mother can pass the virus to her baby during childbirth.

About 10% of individuals infected with Hepatitis B and 25% with Hepatitis C are able to defeat the virus after a short-term infection. The rest carry the virus within them for life. This chronic infection is the most common cause of liver cirrhosis and cancer.

Did you know?

For the period 2011-2015 in Singapore, the three leading causes of cancer deaths in males were lung, colorectal, and liver cancers with 2,346 patients diagnosed with liver cancer, comprising of 7.5% of all cancers detected¹. Hepatitis B vaccination can help towards protect against liver cancer as has been demonstrated in Taiwan and other countries.²

What are the possible complications of Hepatitis A, B, and C?

Chronic hepatitis can silently damage the liver for many years before symptoms occur. Unless closely monitored, many eventually have serious liver problems.

One common complication is cirrhosis, which is scarring of the liver. Cirrhosis can be detected through a liver biopsy. Scar tissue makes it difficult for the liver to perform its functions which can lead to liver failure. Symptoms include weight loss, fatigue, and nausea. In severe cases, you may experience confusion and jaundice.

The other common complication in people with chronic hepatitis B and C infection is liver cancer. These patients will need to be closely monitored even if they feel well.

How should I prepare for my appointment?

In preparation for your appointment, you are advised to bring all your:

● Laboratory results
● Liver pathology reports
● Liver imaging reports (eg CT scans, ultrasounds)
● Hepatitis A&B immunisation records
● Medical history including dates of major surgeries and hospitalisations
● List of medications and supplements
● List of allergies

You should share with your doctor your main concerns as well as symptoms especially if they are new or affect your quality of life.

How do specialists diagnose Hepatitis A, B, and C?

If you have symptoms, a blood test can be done to check for the presence of the virus. If you do have hepatitis, more blood tests may be necessary to check for complications and determine the state of infection (i.e. acute with infection within the past six months, or chronic with the infection occurring for longer than six months). Often, there may be no or vague symptoms.

A liver biopsy may be ordered to determine the extent of the liver damage. A needle is inserted into the liver to draw out a tissue fragment which is then analysed at the lab.

What treatments are available for Hepatitis A, B, and C?

Hepatitis A is almost always an acute infection. No medication is required as it runs its course. Nausea might bother you. Eating several small meals spaced out through the day, drinking fluids to keep hydrated, and avoiding strenuous exercise might help until you feel better.

The goal of treating chronic hepatitis B and C is to control the virus and preventing liver damage. Your doctor will monitor you regularly for liver disease. Regular blood tests, ultrasound examinations, and CT scans may be ordered to check on your liver function and reveal any signs of damage.

Antiviral medication may help depending on your condition. With several drug combinations available, your doctor will help advise you on a suitable drug regimen depending on the type of virus you have, your liver function, and any other medical conditions you may have.

[1] National Registry of Diseases. Singapore Cancer Registry Annual Registry Report 2015. 2017. Accessed November 29, 2017.

[2] Kao J-H. Hepatitis B vaccination and prevention of hepatocellular carcinoma. Best Pract Res Clin Gastroenterol. 2015;29(6):907-917. doi:10.1016/j.bpg.2015.09.011.