What are the main differences between Hepatitis B and Hepatitis C. How do these viruses spread and affect liver health. Which form of hepatitis poses a greater risk to global health. What treatment options exist for Hepatitis B and C.

Understanding Hepatitis: Types, Causes, and Liver Impact

Hepatitis, characterized by liver inflammation, can stem from various factors including alcohol consumption, physical trauma, autoimmune responses, or viral infections. Among the five common types of viral hepatitis (A, B, C, D, and E), Hepatitis B and C stand out due to their potential for chronic infection and severe liver complications.

Both Hepatitis B and C are blood-borne pathogens, primarily transmitted through direct blood-to-blood contact with an infected individual. These viruses can lead to chronic, lifelong infections, potentially resulting in fibrosis, cirrhosis, liver failure, or even liver cancer.

How does hepatitis affect liver function?

Hepatitis-induced liver damage compromises the organ’s ability to filter toxins from the body. This impairment can lead to a cascade of health issues, as the liver plays a crucial role in numerous bodily functions, including metabolism, immune response, and detoxification.

Hepatitis B: The World’s Most Common Liver Infection

Despite the availability of an effective vaccine, Hepatitis B remains the most prevalent liver infection globally. An estimated 292 million people worldwide live with chronic Hepatitis B, surpassing the number of those affected by Hepatitis C.

How is Hepatitis B transmitted?

Hepatitis B is most commonly spread from mother to child during birth. This vertical transmission route contributes significantly to its high prevalence in certain regions. Additionally, the virus can spread through blood-to-blood contact, unprotected sexual intercourse, and sharing of contaminated needles or personal items like razors or toothbrushes.

What makes Hepatitis B particularly dangerous?

• Higher infectivity: Hepatitis B is 5-10 times more infectious than Hepatitis C
• Environmental stability: The virus can survive outside the body for up to 7 days
• Unpredictable progression: Liver cancer can develop without signs of cirrhosis
• Unique viral structure: Covalently closed circular DNA (cccDNA) complicates treatment

Hepatitis C: A Curable but Significant Threat

While Hepatitis C receives more attention and research funding, it affects fewer people globally compared to Hepatitis B. However, it remains a significant public health concern due to its potential for chronic infection and liver damage.

How does Hepatitis C spread?

Hepatitis C is most commonly transmitted through the use of unclean needles for drug injection. It can also spread through blood transfusions (though this is rare in countries with advanced screening methods), sexual contact (less common than with Hepatitis B), and from mother to child during pregnancy or childbirth.

Is there a cure for Hepatitis C?

Yes, unlike Hepatitis B, there is a cure for Hepatitis C. Approved by the FDA in 2013, the treatment consists of antiviral pills taken daily for 8-12 weeks. A cure is defined as a sustained virologic response (SVR), meaning the virus is undetectable in the blood three months after completing treatment.

Comparing the Health Impacts of Hepatitis B and C

Both Hepatitis B and C contribute significantly to liver-related morbidity and mortality worldwide. Together, they account for approximately 80% of global liver cancer cases. However, some key differences exist in their health impacts:

1. Mortality risk: Studies indicate that individuals with chronic Hepatitis B are more likely to die from liver-related complications than those infected with Hepatitis C.
2. Cancer development: In Hepatitis C, liver cancer typically develops after cirrhosis. Hepatitis B can cause liver cancer without apparent cirrhosis, making screening and prediction more challenging.
3. Disease progression: Hepatitis C often leads to a more predictable progression of liver damage, while Hepatitis B can have a more variable course.

Viral Mechanisms: How Hepatitis B and C Attack Liver Cells

The mechanisms by which Hepatitis B and C viruses infect and replicate within liver cells differ significantly, impacting both disease progression and treatment approaches.

How does the Hepatitis C virus replicate?

Hepatitis C follows a more typical viral replication cycle. It enters a healthy cell, hijacks the cell’s machinery to produce copies of itself, and then releases these new viral particles to infect other cells. This process continues, gradually increasing the viral load and damaging liver cells over time.

What makes Hepatitis B replication unique?

Hepatitis B employs a distinctive replication strategy involving covalently closed circular DNA (cccDNA). This unique structure allows the virus to integrate its genetic material permanently into the host cell’s DNA. The cccDNA resides within the cell nucleus, creating a persistent viral reservoir that can lead to reactivation even if surface antigen levels become undetectable.

The presence of cccDNA poses significant challenges for developing a cure for Hepatitis B. Its location within the cell nucleus makes it difficult to target and eliminate without causing harm to the host cell.

Treatment Landscape: Advances and Challenges

The treatment options and outcomes for Hepatitis B and C differ significantly, reflecting the unique characteristics of each virus.

What treatments are available for Hepatitis B?

Currently, there is no cure for Hepatitis B. Treatment focuses on managing the infection and preventing liver damage. Options include:

• Antiviral medications to suppress viral replication
• Interferon therapy to boost the immune response
• Regular monitoring of liver function and viral load
• Lifestyle modifications to support liver health

Research into potential cures for Hepatitis B is ongoing, with strategies targeting cccDNA and novel immunotherapies showing promise.

How has Hepatitis C treatment evolved?

The landscape for Hepatitis C treatment has transformed dramatically in recent years. Direct-acting antivirals (DAAs) have revolutionized therapy, offering:

• High cure rates (over 95% in many cases)
• Shorter treatment duration (typically 8-12 weeks)
• Fewer side effects compared to older interferon-based treatments
• Effectiveness against multiple genotypes of the virus

The availability of generic versions of these medications is improving access to treatment globally.

Prevention Strategies: Vaccines and Public Health Measures

Preventing the spread of Hepatitis B and C requires a multifaceted approach, combining vaccination (where available), public health initiatives, and individual preventive measures.

Is there a vaccine for Hepatitis B?

Yes, an effective vaccine for Hepatitis B has been available since the 1980s. The vaccine is typically administered in a series of three shots over six months and provides long-lasting protection. Many countries have implemented universal infant vaccination programs, significantly reducing the incidence of new infections.

Why isn’t there a Hepatitis C vaccine?

Despite extensive research, developing a vaccine for Hepatitis C has proven challenging due to:

• The virus’s high genetic variability
• Its ability to evade the immune system
• The lack of suitable animal models for testing

Efforts to develop a Hepatitis C vaccine continue, but prevention currently relies on public health measures and individual risk reduction strategies.

What are key prevention strategies for both viruses?

While specific prevention methods may differ, several strategies can help reduce the risk of both Hepatitis B and C infections:

• Practicing safe sex and using barrier methods
• Avoiding sharing needles, syringes, or other drug paraphernalia
• Ensuring proper sterilization of medical and tattoo equipment
• Screening blood donations for both viruses
• Implementing mother-to-child transmission prevention programs
• Raising public awareness about transmission risks and prevention methods

Global Health Impact: The Burden of Hepatitis B and C

Both Hepatitis B and C pose significant challenges to global health, contributing to substantial morbidity, mortality, and economic burden worldwide.

How do Hepatitis B and C impact global health statistics?

The World Health Organization (WHO) estimates that:

• Over 350 million people globally live with chronic Hepatitis B or C
• Viral hepatitis causes approximately 1.4 million deaths annually
• Hepatitis B and C account for 96% of all hepatitis-related deaths

These statistics underscore the urgent need for improved prevention, diagnosis, and treatment strategies on a global scale.

Which regions are most affected by Hepatitis B and C?

The prevalence of Hepatitis B and C varies significantly across regions:

• Hepatitis B is most prevalent in Africa and the Western Pacific
• Hepatitis C rates are highest in the Eastern Mediterranean and European regions
• Co-infection with HIV is a significant concern in certain populations

Understanding these geographical patterns is crucial for targeting public health interventions and allocating resources effectively.

Future Outlook: Research Priorities and Emerging Therapies

The field of hepatitis research is dynamic, with ongoing efforts to improve prevention, diagnosis, and treatment options for both Hepatitis B and C.

What are the current research priorities for Hepatitis B?

Research efforts for Hepatitis B are focused on several key areas:

• Developing strategies to target and eliminate cccDNA
• Exploring novel immunotherapies to boost the body’s natural defenses
• Improving diagnostic tools for early detection and monitoring
• Investigating combination therapies for more effective viral suppression
• Addressing barriers to vaccine uptake and coverage

How is Hepatitis C treatment evolving?

While current treatments for Hepatitis C are highly effective, research continues to:

• Develop pan-genotypic treatments effective against all viral strains
• Shorten treatment duration without compromising efficacy
• Address challenges in hard-to-treat populations (e.g., those with advanced liver disease)
• Improve access to treatment in resource-limited settings
• Explore preventive strategies, including vaccine development

As research progresses, the hope is to develop more effective strategies for managing both Hepatitis B and C, ultimately reducing their global health impact and moving towards the WHO’s goal of eliminating viral hepatitis as a public health threat by 2030.

What’s the Difference: Hepatitis B vs Hepatitis C?

About Hepatitis B, Living with Hepatitis B

January 9, 2019 hepbtalk

With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is part one in a three-part series.

What is Hepatitis?

Hepatitis means “inflammation of the liver”. A liver can become inflamed for many reasons, such as too much alcohol, physical injury, autoimmune response, or a reaction to bacteria or a virus. The five most common hepatitis viruses are A, B, C, D, and E. Some hepatitis viruses can lead to fibrosis, cirrhosis, liver failure, or even liver cancer. Damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins.

Both hepatitis B and C are blood-borne pathogens, which means that their primary mode of transmission is through direct blood-to-blood contact with an infected person. Also, both hepatitis B and C can cause chronic, lifelong infections that can lead to serious liver disease. Hepatitis B is most commonly spread from mother-to-child during birth while hepatitis C is more commonly spread through the use of unclean needles used to inject drugs.

Hepatitis B vs. Hepatitis C

Despite having an effective vaccine, hepatitis B is the world’s most common liver infection; over 292 million people around the world are estimated to be living with chronic hepatitis B. While hepatitis C tends to get more attention and research funding, hepatitis B is considerably more common and causes more liver-related cancer and death worldwide than hepatitis C. Combined, chronic hepatitis B and C account for approximately 80% of the world’s liver cancer cases. However, studies show that those with chronic hepatitis B are more likely to die from liver-related complications than those who are infected with hepatitis C. With hepatitis C, most people develop cirrhosis, or scarring of the liver, before liver cancer. In certain cases of hepatitis B, liver cancer can develop without any signs of cirrhosis, which makes it extremely difficult to predict the virus’ impacts on the body, and makes screening for liver cancer more complicated.

The hepatitis B virus is also approximately 5-10 times more infectious than hepatitis C, and far more stable. It can survive – and remain highly contagious – on surfaces outside of the body for up to 7 days if it is not properly cleaned with a disinfectant or a simple bleach solution. A new study suggests that the hepatitis B virus has the ability to survive in extreme temperatures, whereas the hepatitis C virus has been known to survive outside of the body for a short period of time on room-temperature surfaces. However, more research will need to be done on the topic.

Another major difference between the two forms of hepatitis is how the virus attacks a cell. The hepatitis C virus operates like other viruses; it enters a healthy cell and produces copies of itself that

Hepatitis C Virus
Courtesy of Google Images

go on to infect other healthy cells. The hepatitis B virus reproduces in a similar fashion, but with one large difference – covalently closed circular DNA. Covalently closed circular DNA (cccDNA) is a structure that is unique to only a few viruses. Unlike a typical virus, hepatitis B’s cccDNA permanently integrates itself into a healthy cell’s DNA – a component of the cell that allows it to function properly and produce more healthy cells. The cccDNA resides within an essential area of the cell called the nucleus and can remain there even if an infected person’s hepatitis B surface antigen (HBsAg) levels are undetectable. Its presence means that a person with chronic hepatitis B may have a risk of reactivation even if the HBsAg levels have been undetectable for a long period of time. The complex nature and integration process of cccDNA contributes to the difficulties of finding a cure for hepatitis B. The cccDNA’s location inside of the nucleus is especially troublesome because it makes it difficult to isolate and destroy the cccDNA without harming the rest of the cell.

Hepatitis C, on the other hand, has a cure! Approved by the FDA in 2013, the cure is in the form of an antiviral pill that is taken once a day over the course of 8-12 weeks. For hepatitis C, a cure is defined as a sustained virologic response (SVR), which means that the virus is not detected in a person’s blood 3 months after treatment has been completed. In the United States, an affordable, generic version of the hepatitis C cure is set to be released by Gilead Sciences, Inc. in January 2019.

People living with chronic hepatitis B are susceptible to hepatitis Delta. Only people with hepatitis B can contract hepatitis D as well. Hepatitis Delta is considered to be the most severe form of hepatitis because of its potential to quickly lead to more serious liver disease than hepatitis B alone. Of the 292 million people living with chronic hepatitis B, approximately 15-20 million are also living with hepatitis D. Unlike HIV and hepatitis C coinfections, there are currently no FDA approved treatments for hepatitis Delta. However, there are ongoing clinical trials that are researching potential treatments!

Hepatitis B/C Coinfection

It is possible to have both hepatitis B and C at the same time. The hepatitis C virus may appear more dominant and reduce hepatitis B to low or undetectable levels in the bloodstream. Prior to curative treatment for hepatitis C, it is important for people to get tested for hepatitis B using the three-part blood test (HBsAg, anti-HBc total and anti-HBs). People currently infected with hepatitis B (HBsAg positive) or those who have recovered from past infection (HBsAg negative and anti-HBc positive) should be carefully managed according to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines in order to avoid dangerous elevation of liver enzymes resulting in liver damage.

How to Protect Yourself   

The hepatitis B vaccine is the best way to protect yourself and your family against hepatitis B. Although there is no vaccine for hepatitis C, you can protect yourself from both liver infections by following simple precautions! Simple steps such as not sharing personal items such as razors or toothbrushes, thoroughly washing your hands, and disinfecting surfaces that have been in contact with blood, can keep your liver healthy!

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Comments on this blog are closed. These blogs are not regularly reviewed or updated, and information, data, or practice recommendations/guidelines may have changed. If you have questions about hepatitis B or this blog post, please email [email protected] or call 215-489-4900.

Differences and which is worse

Hepatitis is a virus that causes liver inflammation. Different strains of hepatitis exist, including hepatitis A, B, C, and D.

The most common types of hepatitis are A, B, and C. Hepatitis A is usually a short-term infection while hepatitis B and C can cause long-term, or chronic, infections.

A person can have both hepatitis B and hepatitis C at the same time. This article will examine the difference between these two viruses, the treatment options available, and the outlook for people who have an infection.

Share on PinterestHepatitis is a viral infection that affects the liver.

Hepatitis B and hepatitis C are both viral infections that attack the liver, and they have similar symptoms.

The most significant difference between hepatitis B and hepatitis C is that people may get hepatitis B from contact with the bodily fluids of a person who has the infection.

Hepatitis C usually only spreads through blood-to-blood contact.

Neither hepatitis B nor C spreads through coughing, breast milk, sharing food with, or hugging a person who has the infection.

Many people who have hepatitis do not become aware of it until the infection has advanced.

Read on for more information about hepatitis B and hepatitis C.

Hepatitis B

Exposure to the hepatitis B virus can cause an acute infection within the first 6 months. This short-term illness causes flu-like symptoms.

Although it is possible to acquire hepatitis B through contact with infected blood, transmission often occurs through bodily fluids.

Hepatitis B transmission may occur through sex, and a woman can pass the infection to a baby during childbirth.

Some people may clear the virus from their system, but others will develop chronic hepatitis B.

The Centers for Disease Control and Prevention (CDC) report that the younger a person is when they contract a hepatitis B infection, the more likely it is that they will have a chronic infection.

For instance, an estimated 90 percent of infants with the virus will develop a chronic infection.

Additional key facts about the hepatitis B virus from the CDC include:

• An estimated 850,000 people in the United States have hepatitis B, but the real figure may be closer to 2.2 million.
• Around 257 million people around the world have hepatitis B.
• There are approximately 21,000 new infections in the U. S. each year.
• Transmission often occurs as a result of childbirth, unprotected sex with a person who has the virus, sharing needles or medical equipment that involves blood (such as glucose monitors), or sharing personal items, such as razors or toothbrushes.

Hepatitis C

Hepatitis C can also cause an acute infection. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), an estimated 75 to 85 percent of people with acute hepatitis C will also develop chronic hepatitis C.

However, about 50 percent of people with hepatitis C do not know that they have it.

Additional key facts about the hepatitis C virus from the CDC include:

• An estimated 3.5 million people in the U.S. live with hepatitis C. About 75 percent of those with hepatitis C were born between 1945 and 1965.
• About 41,000 new infections occur in the U.S. each year.
• Transmission occurs due to exposure to infected blood, which can occur through sharing needles, poor infection control, or childbirth.

People who received a blood transfusion or organ transplant before 1992 could also have contracted the infection during this procedure. After 1992, doctors began screening blood for hepatitis C before giving people blood transfusions.

Share on PinterestFever and fatigue are potential symptoms of hepatitis B and C.

Hepatitis B and C can cause similar symptoms in both the acute and chronic infection stages.

Hepatitis B symptoms in the acute phase usually occur within 6 months of the initial virus exposure.

These symptoms can include:

• dark yellow urine
• fatigue
• fever
• joint pain
• nausea
• pale or gray stools
• vomiting
• yellowing of the skin or eyes, called jaundice

Some very young children with hepatitis B do not experience symptoms.

About 15 to 25 percent of people with hepatitis B get chronic liver disease, which can include liver damage, cirrhosis, and liver cancer.

Acute hepatitis C can cause the same symptoms as acute hepatitis B infections. However, hepatitis C is more likely than hepatitis B to become a chronic condition.

Of those with chronic hepatitis C, the CDC estimate that 5 to 20 percent will develop cirrhosis, which is liver scarring. They also state that 1 to 5 percent of people with hepatitis C will die from cirrhosis or liver cancer.

Many people may not recognize that they have hepatitis B or C until they receive screening for other blood disorders.

Others may have symptoms that indicate liver problems, such as fluid retention, pale stools, or bleeding problems.

There is currently no cure for hepatitis B, but a doctor will monitor the symptoms of a person who has the infection and recommend practices that can promote liver health.

Possible recommendations include:

• abstaining from drinking alcohol as it can damage the liver
• avoiding medications that the liver filters, which include nutritional and herbal supplements

Additional hepatitis B treatments depend on an individual’s specific symptoms and any complications that occur.

Since 2013, doctors have been able to prescribe medications that can treat hepatitis C in most people. These antiviral medications include ledipasvir/sofosbuvir (Harvoni) and daclatasvir (Daklinza).

A doctor will prescribe different medications depending on the genotype, or variation, of hepatitis C that a person has. It is usually necessary to take these drugs for 12 to 24 weeks.

Share on PinterestTattoo parlors must maintain good hygiene to prevent hepatitis transmission.

A vaccine exists for hepatitis B. The vaccine stimulates the body to make antibodies, or immune cells, that can fight the hepatitis B infection.

People at risk of exposure to hepatitis B, infants, and people with an HIV infection should get the hepatitis B vaccine.

Many schools and public health initiatives routinely offer the hepatitis B vaccine to children.

There is no vaccine available for hepatitis C. However, certain lifestyle practices can help prevent the transmission of both viruses, including:

• refraining from sharing needles
• practicing safe sex, especially if a person has more than one sexual partner
• training healthcare workers at risk of exposure on needle safety
• ensuring that tattoo parlors use thorough cleaning and safety practices
• avoiding sharing personal care items, such as toothbrushes or razors

Both hepatitis B and C infections can cause short- and long-term effects. However, hepatitis C is more likely to turn into a chronic condition than hepatitis B.

A person can transmit hepatitis B through bodily fluids, while the transmission of hepatitis C usually only occurs through blood-to-blood contact.

A person can reduce their risk of hepatitis B transmission by getting the hepatitis B vaccine. Doctors can often treat chronic hepatitis C.

If a person has risk factors for either form of hepatitis, such as sharing needles, a history of unprotected sex, or a blood transfusion before 1992, they should speak to a doctor about testing.

The most dangerous is hepatitis C

Published: 09.03.2023, 09:21

Hepatitis C – anthroponotic viral disease with parenteral and instrumental infection. Infection is also possible through damaged skin and mucous membranes, the most dangerous transmission factor is blood. Often occurs in the form of post-transfusion hepatitis with a predominance of anicteric forms and is prone to chronicity. Hepatitis C is called the “gentle killer” because of the ability to disguise the true cause under the guise of many other diseases. The causative agent of the disease is the hepatitis C virus.

To understand the risk of hepatitis C, you can scale the chances of patients. Only 20% of patients will be completely cured, and 20% of the remaining 80% will develop cirrhosis of the liver. Among those who develop cirrhosis, 20% will develop liver cancer.

Multifaceted hepatitis C

Hepatitis C virus was discovered only in 1989. There are six main types of the virus – they are called genotypes, which are divided into more than 60 subtypes. Some drugs work on some genotypes and are not effective on others.

The most common genotype of the virus is 1, with subtype 1a more common in the US and 1b in Europe.

Genotype 3 is the second most common genotype and occurs in about 55 million people worldwide. Three-quarters of the cases are residents of the South Asian region or people from it. This is the most aggressive type of virus, which gives a very rapid development of the disease and a high risk of complications in the form of malignant tumors. All currently existing drugs for this type of virus have little effect.

The attention of researchers has always been more focused on the most common first genotype. The very importance of identifying the genotype of the virus for drawing up a treatment regimen and prognosis of the disease was recognized by physicians not so long ago.

The only defense is vigilance

There is no vaccine against hepatitis C. Currently, it is only being developed in various laboratories around the world. The best way to protect yourself from infection is to avoid activities that can lead to infection, mainly injection drug use.

However, this does not guarantee protection against accidental infection through contact with the blood of a patient, for example in a nail salon, if the instruments after a client with hepatitis virus were not properly cleaned and left with blood. Simple quick antiseptic treatment does not kill the virus.

Workers who handle human blood and work without gloves are also at risk. You can also get infected in a medical facility due to insufficient processing of instruments.

Hepatitis C complications

Hepatitis C viruses attack the liver, causing inflammation in it. If the inflammation becomes chronic, then cirrhosis can develop, and the condition of the liver deteriorates rapidly, liver failure develops, which can lead to death. It also increases the risk of liver cancer. For example, in Japan, 90% of people with liver cancer have hepatitis C virus.

Other complications of hepatitis C include glomerulonephritis, portal hypertension, hepatoencephalopathy, porphyria, and associated viral infections such as HIV and other viral hepatitis.

Hepatitis C and HIV

Hepatitis C virus is much more contagious than HIV when comparing the risk of virus transmission by blood-to-blood contact. Both viruses are transmitted in this way, but the likelihood of contracting the hepatitis virus through such contact is 10 times higher.

More than 1/3 of those infected with HIV are also infected with the hepatitis C virus. However, the risk of getting the hepatitis virus through sexual contact is very low, especially when compared with the risk of contracting HIV.

How hepatitis C is treated

Depending on the characteristics of the patients, two-component therapy (an immunostimulant and a virusostatic drug) and a triple therapy in which a protease inhibitor is supplemented are used.

Is hepatitis C curable

Yes, hepatitis C can be cured. And treatment is vital: without it, the liver will receive irreparable damage. However, the treatment has serious side effects: fatigue, fever, depression, flu-like and arthritis-like symptoms, insomnia, a decrease in the level of white blood cells in the blood, and others.

Antiviral therapy is successful in 50-90% of patients, depending on the type of treatment, and reduces the risk of cirrhosis and liver cancer.

Gentle killer

Hepatitis C is called the gentle killer. This is due to the fact that for a long time he does not manifest himself in any way. It can take more than 5 months from the moment of infection to the first symptoms. This is because after infection, the virus takes time to replicate enough to damage the liver.

Moreover, acute hepatitis can, without causing any symptoms at all, go into the chronic stage, and when a person finds out that he is sick, it is too late to be treated: already cirrhosis.

Hepatitis testing

Hepatitis C is diagnosed in two steps. First, a serological test is done to determine antibodies to the virus. The presence of antibodies determines the people who have ever been exposed to the virus. If this test is positive, an analysis is performed to determine the RNA of the virus in the blood. This is necessary to confirm the diagnosis of chronic hepatitis C.

The fact is that 15-45% of those infected due to a strong immune response can themselves suppress the development of the virus. And although they no longer have the virus in their blood, that is, they are not infected, antibodies to it remain.

Which hepatitis can be cured and which cannot be cured? the virus causes a completely different disease.

What are hepatitis A and E viruses?

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Hepatitis A and E viruses belong to the group of viruses with an enteral mechanism of infection. It implies infection “through the mouth.” They are the least dangerous from the point of view of the patient. These viruses always cause an acute illness, never turning into a chronic one.

Hepatitis A is Botkin’s disease, or “dirty hands disease”, it occurs when eating dirty food or water.

A patient with hepatitis A or E almost always recovers and develops lifelong immunity to infection. However, fulminant hepatitis, which is acute liver necrosis, can become a complication. In this case, liver failure appears, often leading to the death of the patient.

There is no specific treatment for hepatitis A and E. However, there are effective and safe preventive vaccines. The hepatitis A vaccine was invented a long time ago, however, it is not on the vaccination calendar in our country. It is known that during outbreaks of hepatitis A there is practically no infection of those who are vaccinated against this infection. And I, for one, am vaccinated.

Hepatitis E is a rarer hepatitis in developed countries with a similar route of infection. A vaccine was created against this virus in China several years ago, but so far it has been approved only in this country.

Hepatitis B and C

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There are also hepatitis B and C viruses that belong to the group of parenteral infections. They become infected through the blood: with intravenous drug use, medical procedures with the use of poorly sterilized instruments, infected blood during transfusions, and so on. Hepatitis B and C viruses cause chronic liver disease in most cases.

According to current estimates, there are about 240 million people with chronic hepatitis B in the world. exceeds 5%. The danger of chronic hepatitis B is that almost a third of patients develop cirrhosis and / or liver cancer.

Against the hepatitis B virus, scientists have developed a preventive vaccine that is safe and provides very good protection against infection. It is based on protein rather than infectious material and is well tolerated by humans. Interestingly, there is now a combination vaccine for hepatitis A and B.

The hepatitis C virus was discovered the latest – in 1989, when I was in the second grade. This virus is extremely difficult for laboratory research. In the case of other viruses, scientists usually take a cell line and try to infect it. And the hepatitis C virus, as it turned out, is not able to develop in almost any standard cell line. In general, research on the hepatitis C virus has been greatly hampered.

An incomplete cellular model was obtained only in 1999.

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A complete infection model appeared only in 2005 – very recently. But by now, scientists know all the key mechanisms for the development of infection in a cell: from infection to the assembly of new viral particles.

We know that this is a very common virus. Why? Most likely, because in most cases the disease begins asymptomatically. Now, according to various sources, 130–150 million people have chronic hepatitis C. In Russia, according to some data, up to 3% of the population suffer from it. In 4/5 cases, hepatitis C becomes chronic. And even in the chronic stage, this virus can be asymptomatic – and it can only be diagnosed by special tests.

Like hepatitis B, hepatitis C is extremely dangerous: it often leads to fibrosis and cirrhosis of the liver. And in a number of patients, eventually – to cancer. As far as I know, the treatment of liver cancer is not very effective and can only be saved from it by transplantation. It is believed that up to 80% of all patients with cirrhosis and liver cancer are patients with chronic hepatitis B and C. There is evidence that even patients who have recovered from hepatitis C have an increased risk of getting cirrhosis or liver cancer.

How to be treated for hepatitis B and C?

Hepatitis B is treated quite poorly. That is, it is easy to suppress, but almost impossible to cure, because it has the so-called ccDNA – double-stranded circular DNA. And it is not yet known how to remove it from already infected cells. Several types of substances are used to suppress infection: nucleoside analogs and interferon alfa and its pegylated forms. However, they do not always work.

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Recently, a drug has been developed against hepatitis B based on inhibition of the cell receptor with which the virus interacts. In the early 2000s, scientists first found a cell line that reproduces the full cycle of the hepatitis B virus and identified the NTCP receptor, the bile acid receptor. And it turned out that when interacting with this receptor, the hepatitis B virus enters the body. Then the researchers took peptides that mimic a fragment of the viral protein that is responsible for binding to it, and developed a drug that is now undergoing clinical trials.

However, all these drugs cannot cure people with chronic hepatitis B.

Unlike hepatitis B, hepatitis C can be cured. He is now responding very well to treatment. Patients are considered cured if, 24 weeks after the end of therapy, viral RNA is not detected by sensitive test systems. In the 2000s, therapy was based on interferon alfa – treatment lasted up to 48 weeks, was very difficult for the patient and ineffective. Six months later, the patient was checked, if he did not have the virus, the patient was considered completely healthy. Then scientists developed direct-acting antiviral drugs, that is, not aimed at the proteins of the virus.

Thanks to them, the number of recoveries (percentage of cure / effectiveness of therapy) has increased.

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And, importantly, the treatment time has been reduced. Currently, there are combinations of direct-acting drugs that can cure up to 99% of patients with a virus of any genotype, and without the use of interferon. It became possible to treat, among other things, HIV-infected patients, who previously represented a separate cohort of patients. Doctors now treat them simply by considering the interactions of hepatitis drugs with antiretroviral drugs. It became possible to treat patients with cirrhosis of the liver, as well as patients before liver transplantation. And this is a huge breakthrough in science.

By the way, I personally work in a laboratory that studies the metabolic processes in hepatitis C virus infection. Although patients can be cured, it is impossible to completely eliminate the risk of cirrhosis, fibrosis and liver cancer. These risks remain. We are exploring metabolic pathways and finding out how the virus affects them and whether it is possible to make a substance that can suppress the pathogenicity of the virus.

Hepatitis D virus, or Parasite on parasite

Hepatitis D virus (or delta virus) is a satellite virus. It was discovered a long time ago by an Italian group of scientists who were trying to find out why patients with chronic hepatitis B had different course and severity of the disease in northern and southern Italy. And the Italians found that patients with a severe course of the disease have some additional delta antigen. Then scientists realized that it was a satellite virus, that is, an incomplete virus. If an ordinary virus is a parasite to a cell, then it is a parasite to a parasite. It carries a short circular RNA and encodes only one antigen (protein). This antigen can be in two different forms – but still it is encoded by a single gene.

This protein can form a virus capsid – the inner shell of a viral particle, but it is not enough to form a full-fledged own virion. To form a viral particle, this virus uses the envelope proteins of the hepatitis B virus. The delta virus protein does not have enzymatic activity, and it uses the host cell apparatus to replicate its genome.

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The number of people infected with delta hepatitis in the world is estimated at 15 million people. There are two different types of infection – coinfection and superinfection.

Co-infection is the simultaneous infection with hepatitis B and delta viruses, and superinfection is the infection of hepatitis D in patients with already established chronic hepatitis B.

In each case, the course of the disease will be different. With coinfection, 95% of cases will develop acute hepatitis, but there will be no chronic disease. But at the same time, there is a fairly high probability of developing the already mentioned fulminant hepatitis. And that’s bad.

In the case of superinfection, as a rule, chronic hepatitis will occur, in which the development of liver fibrosis is sharply accelerated – the growth of connective tissue with the appearance of cicatricial changes, as well as an increase in the risk of cirrhosis and liver cancer.