Overview
Hepatitis is inflammation of the liver, most commonly caused by viral infection (hepatitis A, B, C, D, or E). It can also result from alcohol, medications, and autoimmune conditions. Acute hepatitis resolves in most people; chronic hepatitis B and C can lead to cirrhosis and liver cancer over years.
How common is it?
Hepatitis B infects approximately 296 million people worldwide; hepatitis C around 58 million. Hepatitis A causes an estimated 1.4 million cases annually. In the UK, chronic hepatitis C affects around 80,000 people.
Causes and risk factors
Viral hepatitis is transmitted by different routes depending on type. Hepatitis A and E spread via contaminated food and water. Hepatitis B, C, and D spread through blood, sexual contact, or mother to child.
Common risk factors
- Hepatitis A/E: travel to high-prevalence areas, contaminated food or water
- Hepatitis B: unprotected sex, sharing needles, birth from infected mother
- Hepatitis C: sharing needles or blood-contaminated equipment
- Hepatitis D: only occurs with hepatitis B co-infection
- Alcohol excess causing alcoholic hepatitis
- Autoimmune hepatitis (immune system attacking liver cells)
- Drug-induced hepatitis from paracetamol overdose or certain medications
Symptoms
- Fatigue and general malaise
- Nausea and loss of appetite
- Jaundice (yellowing of skin and whites of eyes)
- Dark urine and pale stools
- Right upper abdominal pain or tenderness
- Joint and muscle aches
- Fever (more common in hepatitis A)
When to see a doctor
Seek medical assessment for jaundice, dark urine, or significant fatigue. Hepatitis B and C are often symptomless for years, so testing is important if you have risk factors. Emergency assessment for signs of liver failure: confusion, severe jaundice, bleeding tendency.
Diagnosis
Blood tests: liver function tests show elevated ALT and AST. Specific viral serology identifies the type (hepatitis B surface antigen, hepatitis C antibody, then viral load PCR). Liver biopsy or fibroscan assesses damage in chronic cases.
Treatments
Antiviral therapy for hepatitis C
Direct-acting antivirals (DAAs) such as sofosbuvir/ledipasvir achieve cure rates above 95% in 8 to 12 weeks, regardless of genotype. This is a genuine cure, not just suppression.
Antiviral therapy for chronic hepatitis B
Tenofovir or entecavir suppress viral replication indefinitely, preventing progression to cirrhosis. Treatment is usually lifelong. Monitoring continues even when viral load is undetectable.
Supportive care for acute hepatitis
Rest, adequate nutrition, and avoidance of alcohol and hepatotoxic drugs while the liver recovers. Most cases of acute hepatitis A and E resolve completely within 1 to 3 months.
Liver transplant
For end-stage liver disease (cirrhosis with decompensation) or acute liver failure. Hepatitis C can be cured before or after transplant.
Self-care and lifestyle
- Avoid all alcohol during hepatitis and for at least 6 months after recovery
- Do not share personal items such as razors or toothbrushes
- Practise safe sex and use barrier contraception
- Vaccination against hepatitis A and B is available and highly effective
Prevention
Hepatitis A and B are vaccine-preventable. Safe needle programmes prevent hepatitis C. Blood supply screening, safe sex, and hand hygiene all contribute to prevention.