The Tribune

By DR LEOPOLDO AROSEMENA, 

Hepatology specialist, 

Cleveland Clinic

Hepatitis can go unnoticed for years – which is why it is important to continue to raise awareness about its effects and how to recognise it.

World Hepatitis Day is held on July 28 – and ahead of the day, expert Dr Leopoldo Arosemena, from the Cleveland Clinic, answers questions on how the disease is spread, how to recognise it and what treatment you will need.

1. Hepatitis is often described as a “silent” disease. Why can many people live with hepatitis for years without showing symptoms?

Many forms of hepatitis, especially chronic hepatitis B and hepatitis C, can cause ongoing inflammation in the liver without producing noticeable symptoms. The liver has a remarkable ability to continue functioning even when it is being damaged. As a result, people may feel completely healthy for years or even decades while liver scarring gradually develops. Symptoms often do not appear until significant liver damage, cirrhosis, or liver failure has occurred.

2. What are the main differences between the different types of viral hepatitis A, B, C, D, and E and which ones represent the greatest public health challenge today?

The five major viral hepatitis infections differ in how they spread and whether they become chronic:

•Hepatitis A (HAV): Spread through contaminated food or water. It causes an acute infection and does not become chronic. A vaccine is available.

•Hepatitis B (HBV): Spread through blood, sexual contact, and from mother to baby during childbirth. It can become chronic and lead to cirrhosis and liver cancer. A vaccine is available. It is not curable but can be controlled with medication.

•Hepatitis C (HCV): Primarily spread through blood exposure, especially from shared needles and sexual contact. It frequently becomes chronic but is now curable with modern antiviral therapies. There is currently no vaccine.

•Hepatitis D (HDV): Only occurs in people who already have hepatitis B because it depends on HBV to survive. It can make liver disease more severe.

•Hepatitis E (HEV): Usually spread through contaminated water and generally resolves on its own, although it can be dangerous during pregnancy.

Today, hepatitis B and hepatitis C remain the greatest public health challenges because they can become chronic infections and are major causes of cirrhosis, liver failure, and liver cancer worldwide.

3. How are hepatitis B and hepatitis C actually transmitted? What myths about transmission are still common among the general public?

Hepatitis B spreads through infected blood and body fluids, including sexual contact, sharing needles, needlestick injuries, and transmission from mother to child at birth.

Hepatitis C is transmitted primarily through blood-to-blood contact, most commonly through sharing needles or other equipment used for injecting drugs. It also can be transmitted sexually. Less common routes include childbirth and certain high-risk exposures.

Common myths include the belief that hepatitis B or C can be spread through:

Hugging

Handshakes

Sharing meals

Coughing or sneezing

Casual social contact

These activities do not transmit hepatitis B or C

4. Who should get tested for hepatitis, even if they feel completely healthy?

Testing is important even for people without symptoms. Individuals who should discuss hepatitis screening with their healthcare provider include:

Anyone who may have been exposed to infected blood.

People who have ever injected drugs.

Healthcare workers with potential blood exposure.

People born to mothers with hepatitis B.

Sexual partners of infected individuals.

Individuals with unexplained liver abnormalities.

Adults who have never been screened for hepatitis B.

People with risk factors for hepatitis B or C.

Since hepatitis often causes no symptoms initially, screening is one of the most effective ways to identify infection before complications develop.

5. How important is early diagnosis, and how does the prognosis change when the disease is detected before complications appear?

Early diagnosis can be life-changing. When hepatitis is identified before significant liver damage occurs, treatments can prevent or dramatically reduce the risk of cirrhosis, liver failure, and liver cancer. For hepatitis C, modern antiviral medications can cure most patients. For hepatitis B, effective treatments can suppress the virus and reduce long-term complications.

Patients diagnosed early generally have a much better prognosis than those whose infection is discovered after advanced liver disease has developed.

6. Many people associate hepatitis only with alcohol consumption. How accurate is this perception, and what are the most common causes of hepatitis?

This is a common misconception. While excessive alcohol use can cause liver inflammation known as alcoholic hepatitis, it is only one of many causes. Hepatitis can result from:

Viral infections (A, B, C, D, and E)

Alcohol-related liver disease

Autoimmune diseases

Metabolic disorders

Certain medications and toxins

Fatty liver disease associated with obesity and diabetes

In clinical practice, viral hepatitis remains one of the most important causes of chronic liver disease worldwide. Alcohol can worsen other liver diseases.

7. What role do vaccines play today in preventing hepatitis, and who should make sure they are protected?

Vaccination is one of the most effective tools for preventing hepatitis. Safe and highly effective vaccines are available for hepatitis A and hepatitis B. Because hepatitis D depends on hepatitis B infection, hepatitis B vaccination also protects against hepatitis D.

People who should ensure they are protected include:

All infants and children according to vaccination schedules.

Unvaccinated adults.

Healthcare workers.

Travelers to areas with higher rates of hepatitis.

Individuals at increased risk of exposure to blood or body fluids.

There is currently no vaccine for hepatitis C or E.

8. If hepatitis is not diagnosed or treated in time, what long-term complications can it cause in the liver and overall health?

Untreated chronic hepatitis can lead to serious complications, including:

Chronic liver inflammation

Fibrosis (scarring of the liver)

Cirrhosis (the highest degree of liver scarring).  Liver decompensation (jaundice, GI bleed, altered mental status, muscle mass loss, etc...)

Liver failure

Portal hypertension

Liver cancer (hepatocellular carcinoma)

Need for liver transplantation

Premature death from liver-related disease

These complications often develop gradually over many years, reinforcing the importance of early detection.

9. What everyday habits can help protect liver health and reduce the risk of liver disease?

To maintain a healthy liver:

Stay up to date on recommended vaccines.

Avoid sharing needles or personal items such as razors and toothbrushes.

Practice safer sex.

Maintain a healthy weight.

Exercise regularly.

Limit or avoid excessive alcohol consumption.

Use medications only as directed.

Seek medical care if you have risk factors for hepatitis.

Get recommended hepatitis screening tests.

Decrease or avoid highly processed food, artificial sweeteners, uncooked pork, game meat

Avoid drinking water that is not potable.

These habits can significantly reduce the risk of hepatitis and other liver diseases.

10. If you could share one key message for World Hepatitis Day, what would be your main recommendation for people to protect their liver health and take action in time?

My message would be simple: “Get tested, get vaccinated, and don't wait for symptoms.”

Hepatitis is often a silent disease, but it is also one of the most preventable and treatable causes of liver damage. Many people live for years without realizing they are infected. Knowing your status, staying up to date on vaccinations, and seeking care early can prevent life-threatening complications and save lives.