The ABCs of Hepatitis: What’s the Difference?

When it comes to the health of your liver, one of the biggest risks, along with alcohol abuse, is a viral illness known as hepatitis. Once a person is infected with hepatitis, the virus typically has a period of dormancy within the body. But then it’s common for the virus to attack the liver, leading to liver swelling, redness and pain, among other signs of inflammation. As hepatitis takes hold in the body, the common symptoms include stomach pain, fever, fatigue, loss of appetite, achy joints and yellowing of the skin and eyes, also known as jaundice.

A, B and C: deciphering the differences

One source of confusion when it comes to hepatitis is understanding the lettering system that's used to identify the different types. Not only is there a hepatitis A, B and C, but there is also a D and an E that are rare in the United States but common in other areas of the world.

These letters simply identify the types of viruses that cause the different illnesses. And along with the viruses being different, there are also some subtle differences among the illnesses themselves.

One key difference among hepatitis types A, B and C, for example, is how the illness impacts the body. With hepatitis A, the infection is an acute one. That means that the virus only infects the body for a short amount of time, and then it tends to resolve on its own, usually within a couple of months. Hepatitis B, on the other hand, is usually an acute infection but can be chronic in some cases. (This means it will stay in the body forever unless it’s treated and cured.) And hepatitis C is almost always a chronic infection.

Of course, there are other key differences among the different forms of hepatitis, as well, including methods of transmission, treatments and more. To help you understand the A, B, and Cs of hepatitis, we offer an in-depth breakdown of the three different types below.

Hepatitis A

The story of hepatitis A in the United States is mostly a good one, with a cautious caveat at the end. Hepatitis A used to be much more common in the United States and led to a lot more infections. But in 1995, a hepatitis A vaccine became available that drastically altered the course of the illness. Rates of infection fell by 95 percent, to an all-time low of 1,239 in 2014, according to the National Institutes of Health (NIH).

Now comes the caveat: Though still low, recent years have seen a rise in hepatitis A rates as drug use and homelessness in the county continue to rise. In fact, the rate in 2017 was 3,366, almost triple that of 2014.

Despite that bit of bad news, the overall news about hepatitis A in the United States is mostly good. Unlike the other major forms of hepatitis, it does not cause a lifelong illness when you get it. However, there have been rare instances of severe hepatitis A that led to rapid liver failure, though this is uncommon.

Hepatitis A is often contracted not from other people but from food and water contaminated with the virus. That's why the disease is more common in less developed parts of the world. However, the disease can also be spread from person to person in ways that are consistent with other forms of hepatitis. This includes having unprotected sex with an infected person, sharing needles while using drugs or caring for a person infected with the virus.

When hepatitis A does occur, the symptoms can be unpleasant and include fatigue, fever, diarrhea, nausea, vomiting, joint pain and jaundice, among others. However, the disease typically resolves within two to seven weeks, and the person gets back to feeling normal. And, the development of the hepatitis A vaccine has made it so the disease can be prevented altogether.

Hepatitis B

One way to look at hepatitis B is as an infection that has some aspects of hepatitis A, which is always an acute illness, and hepatitis C, which is usually chronic and long-lasting. Hepatitis B is usually an acute illness, but the odds of it becoming chronic are higher when the person who gets hepatitis B is younger.

According to the NIH, if a baby is infected with hepatitis B, the odds of the illness becoming chronic are 90 percent. In children ages 2 to 5, the odds of the illness becoming chronic are 25 to 50 percent. But if an adult is infected with hepatitis B, there’s only about a 5 percent chance that the illness becomes chronic.

Hepatitis B is much more common than hepatitis A in the United States. The Centers for Disease Control and Prevention (CDC) estimates that about 20,000 new infections occur each year, and somewhere between 850,000 and 2.2 million people in the United States are living with a chronic hepatitis B infection. The development of a hepatitis B vaccine in the early 1990s has helped keep the rate of new infections under control, reducing the rate of new infections by 82 percent since 1991.

Like hepatitis A, hepatitis B is spread through unprotected sex and sharing needles for drugs. Healthcare workers or people who travel in developing countries are also at a greater risk of getting it. The acute symptoms of hepatitis B are similar to hepatitis A. However, if left untreated, it can ultimately lead to cirrhosis of the liver, liver failure and even liver cancer.

If hepatitis B remains an acute illness, then it is typically allowed to run its course. Treatment may involve supportive measures and treating any symptoms that occur. Chronic hepatitis B, however, will require treatment to prevent liver damage. In recent years, new types of direct-acting antiviral medications for chronic hepatitis have greatly improved cure rates and reduced side effects in people with chronic hepatitis. If there’s any drawback to these medications, it’s that they often have to be taken for several months, and they can be quite costly. There are programs available through insurance providers, states, drug companies and hospitals that can help people afford these medications.

Hepatitis C

As the most common form of hepatitis in the United States, hepatitis C affects from 3 million to 4 million Americans, according to CDC estimates. About 30,000 new cases develop each year, and 75 to 85 percent of hepatitis C cases end up becoming chronic. Part of the reason hepatitis C has proven more difficult to manage than other forms is the absence of a hepatitis C vaccine, though the NIH notes that work in this area is ongoing.

Though hepatitis C has greater risks than other forms of hepatitis, it’s also harder to spread. Typically, it’s passed on through blood to blood contact with an infected person. Avenues for transmission include having unprotected sex with someone with hepatitis C, sharing drug needles or sharing other items such as razors, nail clippers or toothbrushes. Children can also be born with hepatitis C if their mother had the illness while pregnant with them.

Chronic hepatitis C often exhibits no symptoms, which is why the NIH recommends that certain people be screened for the disease. This includes people born between 1945 and 1965, or others who are generally at risk. If chronic hepatitis C is present, the good news is that newer medications have made cure rates much better than ever before (about 90 percent). Still, treatments for chronic hepatitis C can be lengthy and costly.

The final word

There’s no questions that hepatitis can be a concerning diagnosis, but the outlook for the disease is currently better than at any point in history. Vaccines for hepatitis types A and B have reduced the risk of developing the disease in the first place, and new direct-acting antiviral medications have vastly improved outcomes for people who develop chronic hepatitis infections.