Hepatitis is any inflammation or irritation that causes damage, fibrosis or scarring of the liver. With much hardening or scarring of the liver, it can no longer perform the critical functions of the liver and the infected person will die without such measures as a liver transplant. Chronic hepatitis is the number one reason for liver transplants in the U.S. “Chemical” causes of liver inflammation and damage include medications like Tylenol and HIV drugs but especially alcohol and many “party” drugs. Several different strains of viruses can also cause inflammation and damage to the liver during their acute stages (when symptoms are present), but also during their chronic stages (when symptoms have passed or otherwise not present). Different strains of hepatitis virus have more or less severe symptoms, cause differing amounts of damage to the liver over different periods of time and have different treatment or prevention methods. The most important varieties of hepatitis viruses affecting gay men have been labeled Hepatitis A, B, and C (HAV, HBV and HCV) because they were discovered and studied in that order.
Symptoms:
Hepatitis, whether chemical or viral, has the same basic symptoms which all have to do with reduced or interrupted liver functioning. They can include some or all of the following to differing degrees in each case:
- Flu-like illness that doesn’t go away
- Nausea and vomiting
- Diarrhea
- Loss of appetite and body weight
- Jaundice (yellowing of skin or whites of the eyes)
- Dark yellow or brown urine, pale colored feces
- Extreme fatigue
- Abdominal pain
- Swollen glands, skin rash
- Fever
For more complete information and resources for Viral Hepatitis, go to the following sites: www.cdc.gov/hepatitis or www.liverfoundation.org.
 Hepatitis A (HAV)
HAV is the most common variety of Hepatitis infection. Fully one-third of the U.S. population has antibody evidence of past exposure to or infection with HAV. Once exposed to HAV, the body is immune to further infection. HAV has the most frequent and severe acute stage, but virtually all cases resolve themselves in 3 to 6 months and can now be prevented by a vaccine which is increasingly given as part of childhood inoculations. HAV infection may cause extensive liver damage but the infection is never chronic.
How it's spread:
The Hepatitis A virus is found only in human feces. It can be passed on if even a tiny amount of feces from a person with hepatitis A is ingested by mouth, such as from the unwashed hands of restaurant workers. This means the virus can also be passed on sexually through practices involving oral-anal contact.
Treatment for Hep A:
There is no specific treatment for Hepatitis A except for treatment of severe symptoms in the acute phase which can last up to 6 months. Bed rest is usually recommended during the acute phase until symptoms decline. People who have had Hepatitis A should reduce or avoid alcohol consumption and any substances or medications that are highly toxic to the liver, especially pain killers with acetaminophen like Tylenol. People exposed to Hepatitis A are immune thereafter and are not infectious except for a small number of chronic “carriers” who can transmit the infection even though they have no outward symptoms.
Prevention:
Since Hepatitis A can be transmitted by small particles of infected stool entering the mouth though indirect anal contact or rimming, unvaccinated persons should use condoms, gloves or dental dams. Thorough washing of the anal area, hands, genitals and sex toys can help reduce the risk of sexual transmission. However, because Hepatitis A can also be passed on by eating infected food or drinking infected water, a vaccination is recommended for everyone whether sexually active or not.
For more information on HAV inoculations click on the following link: www.immmunize.org.
Hepatitis B (HBV)
HBV usually has a less severe acute stage and many who are infected will have few or only short-lived symptoms. Many will have no symptoms at all and 90-95% of those infected will recover fully with life-long immunity. Up to 10% of those infected will develop mild to severe chronic HBV, which in the long run can lead to cirrhosis or liver cancer.
How it's spread:
HBV is transmitted through exposure to the sexual fluids or blood of an infected person. HBV is not transmitted through such causal contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs. However, since HBV is also found in saliva, it can be transmitted by close oral contact such as deep kissing or by sharing toothbrushes with an infected person.
Treatment for Hep B:
Acute Hepatitis B is similar to HAV and usually goes away by itself so does not normally require medical treatment. If severe, symptoms such as vomiting or diarrhea may require treatment to restore fluids and electrolytes. Decisions to treat chronic HBV infections are made on a case by case basis in consultation with medical experts. Treatment success rate is 30% - 40% with interferon injection treatments that may last as long as one year.
Prevention:
There is now an effective HBV vaccine as well as a Hepatitis A and B combo vaccine. Since Hepatitis B is transmitted by infected blood or semen entering the body use of condoms, gloves and dental dams can provide protection for those who are not vaccinated. Not sharing needles, toothbrushes, razors or tattooing and body piercing equipment will also help to prevent transmission of HBV.
For more information on HBV inoculations click on the following link: www.immmunize.org.
|
 |
 Hepatitis C (HCV)
|
Acute symptoms similar to HAV and HBV are relatively rare for those infected with HCV so a vast majority of those infected with HCV are not aware of it. 75% - 85% of those infected will become carriers of HCV with only 15% - 20% being able to clear the virus on their own. This means that a “silent” epidemic of HCV is occurring in the U.S. with some 3 to 4 million people chronically infected and an estimated 8,000 – 12,000 deaths occurring
each year from HCV-related complications like cirrhosis or liver cancers. This is approximately equal to the number of HIV/AIDS related deaths in the U.S. each year. Among injection drug users, infection rates range from 60-90% and among those infected with HIV those also infected with HCV range from 40-50%. HCV is found only in blood and so is only rarely sexually transmitted.
How it's spread:
- By sharing contaminated needles, straws or other drug-paraphernalia.
- By using non-sterilized equipment for tattooing, acupuncture or body piercing
- By unprotected sex with someone who is infected when blood is present. Rough sex, fisting or sex with someone who is infected and who has sores on their genitals that may bleed. Sexual transmission is extremely rare when no blood is present.
- On rare occasions, from an infected mother to her baby, mainly during delivery. The risk may be greater if the mother is also infected with HIV.
 Top
Treatment for Hep C:
Because symptoms are usually mild or absent acute HCV most often goes undiagnosed and as a result is not frequently treated. Progression of liver disease is very slow in most cases, with complete liver failure not occurring for 10 to 20 years or more. By the time HCV is detected in most people it has already progressed to long-term (chronic) infection accompanied by serious liver damage and complications. Because most people have no symptoms, the only way to confirm HCV infection is by a specialized blood test.
Decisions to offer treatment are made on a case by case basis in consultation with medical professionals, but the trend is toward early diagnosis and treatment before too much liver damage has been done. Only a liver biopsy can detect how much the liver has been damaged at any point in time. New Pegylated Interferon treatments are more effective and have fewer side effects with a shorter regimen of weekly injections than older interferon treatments that had many severe side effects.
Two major genotypes of the Hepatitis C virus have been identified which have different success rates for treatment. Genotype 1 has a success rate of 40-65%, while genotype 2 (most common in the U.S.) has a success rate of 75-88%. New treatment drugs that are under development are expected to be even more effective with fewer side effects. Those who are co-infected with HIV have much lower successful treatment rates, perhaps only half the average success rates of those not co-infected. Currently there is no vaccination to prevent HCV.
Top
Prevention:
The most efficient method of transmitting Hepatitis C is through injection of contaminated blood, as might happen during injection drug use. Never share objects such as needles, razors, toothbrushes, nail files or clippers with a possibly infected person because, unlike HIV, dry blood infected with HCV is still a potential source of Hepatitis C transmission. When getting a manicure, tattoo, or body piercing, make sure sterile instruments are used and that the institution is licensed because tattoo ink can also be contaminated. Use of latex condoms or gloves during sex that involves any blood can also prevent transmission of Hepatitis C.
For more complete information and resources for HCV, go to the following website: www.cdc.gov/hepatitis.
Top |
 |
