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Hepatitis - Prognosis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of hepatitis.

Prognosis:

Hepatitis A

Hepatitis A is the least serious of the common hepatitis viruses. It only has an acute (short term) form that can last from several weeks to up to 6 months. It does not have a chronic form. Most people who have hepatitis A recover completely. Once people recover, they are immune to the hepatitis A virus.

In very rare cases, hepatitis A can cause liver failure (fulminant hepatic failure) but this usually occurs in people who already have other chronic liver diseases, such as hepatitis B or C.

Hepatitis B

Hepatitis B can have an acute or chronic form. The vast majority (95%) of people who are infected with hepatitis B recover within 6 months and develop immunity to the virus. People who develop immunity are not infectious and cannot pass the virus on to others. Still, blood banks will not accept donations from people who test positive for the presence of HBV antibodies.

About 5% of people develop a chronic form of hepatitis B. People who have chronic hepatitis B remain infectious and are considered carriers of the disease, even if they do not have any symptoms.

Chronic hepatitis B infection significantly increases the risk for liver damage, including cirrhosis and liver cancer. In fact, hepatitis B is the leading cause of liver cancer worldwide. Liver disease, especially liver cancer, is the main cause of death in people with chronic hepatitis B.

Patients with hepatitis B who are co-infected with hepatitis D may develop a more severe form of acute infection than those who have only hepatitis B. Co-infection with hepatitis B and D increases the risk of developing acute liver failure. Patients with chronic hepatitis B who develop chronic hepatitis D also face high risk for cirrhosis. Hepatitis D occurs only in people who are already infected with hepatitis B.

Hepatitis C

Hepatitis C has an acute and chronic form but most people (75 - 85%) who are infected with the virus develop chronic hepatitis C. Chronic hepatitis C poses a risk for cirrhosis, liver cancer, or both.

  • About 60 - 70% of patients with chronic hepatitis C eventually develop chronic liver disease.
  • About 5 - 20% of patients with chronic hepatitis C develop cirrhosis over a period of 20 - 30 years. The longer the patient has had the infection, the greater the risk. Patients who have had hepatitis C for more than 60 years have a 70% chance of developing cirrhosis.
  • Of these patients, about 4% eventually develop liver cancer. (Liver cancer rarely develops without cirrhosis first being present.)
  • About 1 - 5% of people with chronic hepatitis C eventually die from cirrhosis or liver cancer.

Patients with chronic hepatitis C may also be at higher risk for non-liver disorders, including:

  • Cryoglobulinemia (a disorder in which protein clumps form in the blood). This can cause skin rash and ulcers, kidney problems, arthritis, and sensations (such as tingling or pain) in the hands and feet. People with such symptoms may have particular difficulties with interferon, which can have similar side effects.
  • Porphyria cutanea tarda (a disorder that causes skin color and texture changes and sensitivity to light)
  • Type 2 diabetes, particularly among younger people with hepatitis C who are overweight
  • Glomuerulonephritis, a kidney disease caused by inflammation of the kidney
  • Certain types of lymphomas (cancers of the lymphatic system), such as non-Hodgkin's lymphoma

Resources

References

Advisory Committee on Immunization Practices (ACIP) Centers for Disease Controland Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007 Oct 19;56(41):1080-4.

American Academy of Pediatrics Committee on Infectious Diseases. Hepatitis A vaccine recommendations. Pediatrics. 2007 Jul;120(1):189-99.

Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008 Oct 2;359(14):1486-500.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008 Jun 3;148(11):ITC6-1-ITC6-16.

Lai CL, Gane E, Liaw YF, Hsu CW, Thongsawat S, Wang Y, et al. Telbivudine versus lamivudine in patients with chronic hepatitis B. N Engl J Med. 2007 Dec 20;357(25):2576-88.

Lok ASF and McMahon BJ. American Association for the Study of Liver Diseases Practice Guidelines: Chronic Hepatitis B. Hepatology. 2007;2:507 -539.

Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet. 2008 Jul 26;372(9635):321-32.

Mukherjee S, Sorrell MF. Controversies in liver transplantation for hepatitis C. Gastroenterology. 2008 May;134(6):1777-88.

National Institutes of Health. Consensus Development Conference Statement: Management of Hepatitis B. October 20 -22, 2008.

Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc. 2007 Aug;82(8):967-75.

Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003620.

Scott JD, Gretch DR. Molecular diagnostics of hepatitis C virus infection: a systematic review. JAMA. 2007 Feb 21;297(7):724-32.

Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007 Oct 25;357(17):1685-94. Epub 2007 Oct 18.

Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20

  • Reviewed last on: 12/5/2008
  • Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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