What's the Difference Between Hepatitis A, B, and C?

What's the Difference Between Hepatitis A, B, and C?

Hepatitis means inflammation of the liver and is often caused by a virus, which comes in different strains. The most common strains of hepatitis are Hepatitis A, B, and C. 

“Hepatitis A,B, and C, like all viruses, are contagious, but they differ mainly by the way they are spread,” says Stella Badalova, PharmD, Director of Healthcare Relations and Clinical Development at Medly Pharmacy. “Hepatitis B and C virus infections can become lifelong infections while Hepatitis A does not. There are vaccines to prevent hepatitis A and B only.” 

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The World Health Organization (WHO) estimates that in 2015, 257 million people globally suffered from Hepatitis B, while 71 million people worldwide suffered from Hepatitis C. Both of these types of hepatitis may cause lifelong infection; according to WHO, in 2015 1.34 million people died from liver cancer, cirrhosis, and other conditions caused by chronic viral hepatitis. 

Viral hepatitis symptoms are similar no matter which type of hepatitis you have and include the following: 

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Fever
  • Loss of appetite
  • Fatigue
  • Dark urine
  • Joint pain
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting 

For all types of viral hepatitis, symptoms are less common in children than in adults, and people of any age with a Hepatitis C viral infection are less likely to experience symptoms.

Hepatitis A 

Hepatitis A is spread by close personal contact, such as sex or living in the same household. The virus that causes it, HAV, is found in the feces of people with Hepatitis A and can be spread by eating food or drinking water that has been contaminated with HAV.

“When and if there are symptoms they present as fatigue, feeling tired, nausea, vomiting, lack of appetite, fever (temperature greater than 100.4 F or 38 C) and pain where the liver is located (on the upper right side of the abdomen).  In more progressive illness symptoms such as darker urine, lighter colored stools, jaundice (yellowing of skin and whites of the eyes) and itchy skin may develop,” says Badalova. 

The incubation period -- the amount of time during which you can give the disease to others, but are not showing symptoms yourself -- is 15 to 50 days, or on average, 28 days.  

“No treatments are available for HAV but fortunately most people recover with supportive treatments at home such as rest and adequate hydration. Complete recovery time averages between 3-6 months; however, some people infected with HAV may experience 6-9 months due to prolonged or relapsing symptoms,” Badalova says. 

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“Once an individual recovers from HAV, they develop immunity to HAV and will never get infected by it again. In addition, unlike other forms of hepatitis, HAV does not cause chronic liver disease as a result of their infection.”

Safe and effective vaccines have been available in the US since 1995 to help prevent HAV transmission. 

Hepatitis B

HBV, the virus that causes Hepatitis B, is found in blood and certain other body fluids. The virus spreads when blood or body fluid from an infected person enters the body of another person.

Methods of transmission include unprotected sex with an infected person, sharing needles, exposure to needle sticks or other sharp objects on the job, or from an infected mother to her baby during birth. Exposure to infected blood in ANY situation risks transmission.

The incubation period for Hepatitis B is 60 to 150 days, or an average of 90 days. Exposure to  HBV can cause an acute infection within the first 6 months, leading to flu-like symptoms.

While there is no medication for recently acquired HBV infection, several antiviral medications are currently licensed for the treatment of individuals with chronic HBV. These drugs do not eliminate the virus but instead prevent serious liver problems. Liver transplant is a treatment of last resort. 

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“Treatment for Hepatitis B depends on if it is an acute or chronic diagnosis. If the doctor determines that the HBV is acute they will commonly recommend: rest, proper nutrition and fluids while the immune system fights the infection,” says Badalova. 

“However, if the doctor determines that the HBV infection is chronic, the treatment will include antiviral oral medications such as entecavir (Baraclude) and tenofovir (Viread), which are the most common ones. The medication helps by fighting the virus and slowing the damage done to the liver by the virus. 

“Another type of antiviral agent used to treat HBV is interferon, an injectable medication used to treat chronic forms of hepatitis. Unlike the oral therapy, which might have to be taken life-long, interferon is given for a specific duration. The PEGylated interferon (Pegasys) is a long acting interferon which is administered once a week for one year. However, only individuals who do not have cirrhotic liver are eligible for the interferon injection.” 

People with chronic HBV infection should have a medical evaluation for liver disease every 6–12 months. 

A vaccine for Hepatitis B is also available. In addition, there is a combination vaccine approved for adults that protects people from both hepatitis A and hepatitis B. 

Hepatitis C

HCV, the virus that causes Hepatitis C, is found in blood and certain other body fluids. The virus is spread when blood or body fluid from an HCV-infected person enters another person’s body. 

HCV is spread through sharing needles when using drugs, through exposure to needle sticks or other sharp objects on the job, or sometimes from an infected mother to her baby during birth. While it is possible to transmit HCV during sex, it is not common.

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“The majority of acute infections of Hepatitis C Virus go on to develop a chronic infection. There is a much greater chance to develop chronic infection with HCV than HAV and HBV. Most people with HCV have no symptoms and when they do develop they are so mild that it is difficult to link it to the infection,” says Badalova.

The incubation period for Hepatitis C is anywhere from 14 to 180 days, or an average 45 days.

Treatment does exist for individuals with chronic HCV infection. Combination therapy is currently the treatment of choice and can eliminate the virus in approximately 40–50% of patients with genotype 1 (the most common genotype in the U.S.). Vaccination against Hepatitis A and B is advised, as is avoiding alcohol. 

“Treatment options for HCV include antiviral medications both oral and injections that if taken appropriately will lead to no Hepatitis C virus detected in the blood work at least 12 weeks after completion. Some oral FDA-approved medications for HCV include: Epclusa, Harvoni, and Mavyret. HCV can also be treated with interferon such as pegylated interferon (Pegasys),” says Badalova. “The specific type of treatment depends on the genotype involved along with individualized therapy that best suits the patient.”

No medication treatment exists for recently acquired HCV infection, and no Hepatitis C vaccination currently exists. “Fortunately, there are many different types of medications and treatment that are continuously being developed. Once cured from HCV, a person is not immune to it and can get reinfected,” says Badalova.

People with chronic HCV infection should be evaluated for liver disease every 6–12 months. 

The Differences Between Hepatitis A, B and C

The major difference between Hepatitis B and C is that Hepatitis C usually only spreads through blood-to-blood contact, while people may get Hepatitis B from the bodily fluids of an infected person.

Neither Hepatitis B nor C spreads through any of the following: 

  • Coughing
  • Breast milk
  • Sharing food with an infected person
  • Hugging an infected person

Hepatitis A is not a chronic infection, while chronic infections can and do occur in Hepatitis B and C.  

Hepatitis A, B and C can seem similar at first, but the similarities and differences between them are critical to know, especially for those who may be exposed. The liver is one of the most important organs in the body, so it is advisable to stay aware of your risk of liver disease, including the different strains of hepatitis. 

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