July 28, 2021 by Dr. Tooran Masoumi

Hepatitis is inflammation of the liver, most often caused by infection with a virus, but sometimes by alcoholism, or poisoning by a drug or chemical. Symptoms vary a lot from person to person and depend on the cause of the hepatitis. Viral hepatitis is classified from A to G according to the family of the virus involved.

Acute hepatitis, chronic hepatitis

Acute hepatitis corresponds to the six months following contamination with one or more hepatitis viruses. Depending on the case, you may not feel anything, be tired, have or not have a fever, nausea, jaundice (yellow eyes). In case of acute hepatitis, it is recommended to consult a doctor, avoid drinking alcohol and even taking certain medications. Rarely, acute hepatitis can unfortunately destroy the liver quickly and irreparably and require a liver transplant.

During acute hepatitis, depending on the case, the virus may be eliminated or may remain in the body. If it persists for more than six months, you have chronic hepatitis. This can cause more or less damage to the liver, which can appear several years or decades after infection. The course varies from person to person and according to the situation (HIV infection, alcohol consumption, age, etc.).

Cirrhosis, fibrosis

By defending itself against the virus and therefore by the destruction of infected cells, the liver becomes hard and fibrous. This is fibrosis, the measure of which assesses the severity of hepatitis (measured from F0, which means there is no fibrosis, to F4, which indicates cirrhosis). This healing process reduces the liver’s ability to regenerate and perform its functions.

Cirrhosis, fibrosis


Viral hepatitis is named by letters of the alphabet. Among them, the most frequent are viral hepatitis C, then B, then A, D (or delta) and finally hepatitis E. The B and C viruses cause hepatitis which sometimes heals spontaneously in phase acute, but which can become chronic. Hepatitis A resolves on its own after causing great fatigue, and never becomes chronic. We will detail the effects and risks of the main hepatitis named above:

1- Hepatitis A and E or VHA and VHE

These are viruses found in the feces of affected people. A person gets contaminated by mouth, on contact with unsuitable or contaminated water or food. These two hepatitis are therefore particularly common in areas where hygiene, sewage disposal or disinfection practices are poor.

After an acute, very tiring phase, the body eliminates the virus. Hepatitis A or E never becomes chronic. In some cases, hepatitis can be serious. There is no treatment against these two hepatitis but a vaccine against hepatitis A exists.

Vaccination is recommended from the age of 1 year for all travelers staying in countries with poor hygiene (Africa, Asia, Middle East, Latin America)


15 to 45 days after infection, hepatitis A shows signs of the flu (flu syndrome):

  • fatigue that can last several weeks or even months;
  • headache;
  • loss of appetite;
  • nausea;
  • hives;
  • muscle and joint pain;
  • jaundice may appear gradually.

In the majority of cases, the disease remains mild and resolves spontaneously. However, it can be serious and even fatal in elderly or vulnerable adults (for example with liver disease). Treatment for hepatitis A is based on rest, withholding alcoholic beverages, and not using medication without medical advice. Eventually, drug therapy with cholestyramine can relieve the itching.

Hepatitis E is caused by a virus. It is spread through contaminated food and water. It is rife in the tropics and subtropics, in all seasons. Its symptoms are the same as those of hepatitis A. It is usually mild, except in pregnant women. Treatment consists of relieving the symptoms. There is no vaccine against hepatitis E.


Hepatitis B is a disease of the liver caused by a virus that is spread mainly through sex or through contact with infected blood. This infection is mild in most cases. But in about 10% of those infected, hepatitis B becomes a chronic infection that can cause serious conditions, such as cirrhosis or liver cancer.

Worldwide, an estimated 2.5 billion people are infected or have been infected with the hepatitis B virus, or one in three! Hepatitis B is the most common viral hepatitis. Currently, around 350 million people suffer from chronic hepatitis B, and cancer complications of the disease are estimated to cause one million deaths each year, making hepatitis B the second leading cause of cancer death after cancer. tobacco.

Hepatitis B is caused by a virus called the hepatitis B virus (HBV). This virus is very contagious: ten times more than that of hepatitis C and a hundred times more than that of HIV / AIDS. This characteristic is partly explained by the fact that the hepatitis B virus can survive for a week in the open air (therefore on objects). In addition, it is resistant to alcohol.

The hepatitis B virus is spread through contact with the blood of an infected person and its fluids: semen, vaginal fluids and breast milk.

An unvaccinated person can be infected with:

  • unprotected sex with an infected person. At the very beginning of a hepatitis B infection, the virus is also present in the saliva.
  • sharing of material that has been in contact with the blood of the infected person: toiletries (toothbrush, razor, scissors, nail clippers, tweezers, etc.), piercing jewelry (piercing, earring) , but also equipment used during drug injection or inhalation: needle, syringe, cotton, spoon, straw, etc.
  • direct contact with the blood of an infected person. There is currently no risk of transmission of hepatitis B by blood transfusion, but healthcare professionals have a higher risk of contamination (needles, syringes, surgery, dentistry, etc.).
  • a tattoo, a piercing or an acupuncture session, if they are carried out without respecting the essential hygiene rules (disposable or sterilized equipment according to the standards in force).
  • childbirth or breastfeeding, when the mother has hepatitis B.

There is no transmission of the hepatitis B virus through water, food, sharing of cutlery or the use of communal toilets. Physical contact (handshakes, kisses, massages, etc.) does not transmit the hepatitis B virus.


After infection, the incubation period for hepatitis B can last for several weeks. Then, flu-like signs appear for a few days and then disappear. In 20 to 40% of cases, symptoms then appear: severe fatigue, jaundice, dark urine, nausea, loss of appetite, stomach pain on the right side, and sometimes itching. This phase lasts a few months. If, after 6 months, the hepatitis B virus is still present in the blood, it is called chronic hepatitis B.

For two to three months after infection, the amount of virus in the body is very large, even if the infected person has no symptoms. It is therefore contagious for those around it.

In the vast majority of cases (98% of infections), the course of hepatitis B is not serious. Nine out of ten people will eliminate the virus thanks to their immune system: they heal spontaneously and are immune because they have made antibodies against HBV.

In 10% of those infected (15% in men, 5% in women), the hepatitis B virus will stay in the liver where it will be more or less active. This activity leads to chronic hepatitis. People who are said to be “immunocompromised”, meaning people whose immune defenses are weakened (for example, cancer chemotherapy, dialysis, HIV / AIDS), develop chronic hepatitis more frequently (40% of cases).

People with chronic hepatitis B are carriers of HBV, usually without any particular health problem. But in 20% of these people, complications develop without medical supervision and treatment.


Hepatitis C is a chronic infection of the liver caused by a virus that is transmitted through the blood. If this infection resolves spontaneously in 20% of infected people, hepatitis C becomes a chronic disease in 80% of cases. When this disease is not diagnosed and treated in time, it can lead to cirrhosis and even liver cancer. Its screening aims to offer treatment to infected people. In fact, antivirals can now cure 95% of patients treated.

The hepatitis C virus, which has invaded and multiplied in the liver, has a strong adaptive capacity. It regularly changes its exterior appearance (it “mutates”) to escape the body’s immune defense mechanisms. This phenomenon of rapid mutation explains why only two in ten infected people manage to eliminate the virus without treatment. For the other eight, hepatitis C becomes a chronic disease: the virus continues to multiply more or less intensely in the liver. Most often, this chronic phase does not cause symptoms for dozens of years.


After contamination, an acute phase occurs 4 to 12 weeks after contamination and lasts a few months. It usually goes unnoticed or can be accompanied, in 30% of cases, by flu-like symptoms. In 80% of cases, hepatitis C becomes a chronic disease. Most often, no symptoms are present for tens of years, although there is a tendency towards lasting fatigue and even mood disturbances. Without medical supervision and treatment, cirrhosis or even liver cancer can develop.


Globally, there are at least 170 million people infected with the hepatitis C virus, with the highest infection rate observed in Africa (5% on average, up to 20% in Egypt).

People most commonly affected by hepatitis C are intravenous drug users, the inmates and people with HIV / AIDS (who are co-infected with the hepatitis C virus in 25% of cases).

Hepatitis C is caused by a virus called the hepatitis C virus (HCV). This virus is very resistant and can survive for a week in the open air (on surfaces or objects). Genetic analysis of HCV shows that there are six types (“genotypes”) and various subtypes. People contaminated by blood transfusion are mainly carriers of genotype 1, while genotype 2 is rather observed in intravenous drug users. In Africa, genotype 4 is predominant.

Knowing the genotype is important for setting up treatment. In fact, it will be shorter in people with genotype 2 or 3 HCV, these two genotypes being more sensitive to currently available treatments.


The hepatitis C virus is spread only through contact with infected human blood. A person can be infected with:

  • sharing material that has been in contact with the blood of an infected person, such as toiletries (toothbrush, razor, scissors, nail clippers, tweezers, etc.) or piercing jewelry (piercing, earring);
  • the exchange of equipment used when injecting drugs (needle, syringe, cotton wool, spoon) or when inhaling drugs (for example, a straw contaminated with bleeding from the lining of the nasal cavities);
  • medical care with bloodshed: healthcare professionals can accidentally contaminate themselves (needles, syringes, surgery, dentistry, etc.);
  • tattoos, piercing or an acupuncture session, if they are carried out without respecting the essential hygiene rules (disposable or sterilized equipment according to the standards in force);
  • transmission from mother to child, mainly during childbirth: this remains rare (3 to 5% of cases unless the mother is co-infected with HIV / AIDS, which brings the risk to 25% cases). For unknown reasons, the risk of mother-to-child transmission is higher if the newborn is a boy.
  • unprotected sex, only if blood is present: period of menstruation, small wounds on the genitals due to sexually transmitted infections or abrasions, sadomasochistic practices, etc.

There is no vaccine against the hepatitis C virus. Attempts to develop such a vaccine have come up against the ability of HCV to transform rapidly to escape control of the immune system.

There is no transmission of the hepatitis C virus through water, food, sharing of cutlery or the use of communal toilets. Physical contact (handshakes, kisses, massages, etc.) does not transmit the hepatitis C virus.


Hepatitis D is a viral hepatitis that can only occur in people who already have hepatitis B (it affects about one in twenty hepatitis B patients). This is because the hepatitis D virus (HDV) needs the presence of the hepatitis B virus to infect liver cells.

The mode of transmission of the hepatitis D virus is the same as that of the hepatitis B virus. Infection with HDV can occur at the same time as that with HBV, or occur later, in a person. who has acute or chronic hepatitis B.

The course of hepatitis B is often worsened by the presence of the hepatitis D virus.

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