The ABCs of Hepatitis: How to Protect Yourself Against Viral Liver Diseases

Two viruses you may have heard of are hepatitis B (HBV) and hepatitis C (HCV).

Dr. Anthony J. Choi, an assistant professor of medicine at the Center for Liver Disease and Transplantation and a transplant hepatologist at Weill Cornell Medicine, says there are major differences between the two.

For example, he says, HBV is vaccine-preventable but can often become a lifelong illness when a patient is infected at a young age. Often transmitted from mother to child at birth, it is usually not curable. However, the virus can be controlled effectively with medication.

On the other hand, while there is no vaccine for HCV, it can be completely cured with oral medicines.

Left untreated, both hepatitis B and C can lead to end-stage liver disease. That’s why it’s so important for all adults to be screened at least once for these two viral infections. A simple blood test at your doctor’s office or at an urgent care facility in your neighborhood will easily detect the presence of HBV or HCV. Or if you happen to donate blood, it will automatically be screened for these two viral infections, and you will be notified if you are positive.

But what about hepatitis A?

Hepatitis A, caused by the hepatitis A virus (HAV), also bears mention, although it causes far fewer deaths worldwide compared to HBV and HCV.

Like HBV, hepatitis A is vaccine-preventable.According to the Centers for Disease Control (CDC), HAV is highly contagious. It is spread through close personal contact with an infected person or through consuming contaminated food or drink. Most people who catch hepatitis A do not have long-lasting illness; its symptoms usually clear up within 2 months.

The best way to prevent hepatitis A is to get vaccinated. The HAV vaccine is recommended for children, as well as certain adults (such as international travelers). It’s always a good idea to reach out your doctor’s staff and ask if and when you need the shot.

What are the main symptoms of hepatitis B and C?

“As with many liver diseases, the symptoms of viral hepatitis are often nonexistent or vague: fatigue, poor appetite, gastrointestinal upset or yellowing of the eyes or skin,” Dr. Choi says. “Perhaps surprisingly, patients may report similar symptoms whether they’re newly infected or already have cirrhosis, a condition of severe scarring of the liver leading to end-stage liver disease. You may be chronically infected with HBV or HBC and not have symptoms for years or even decades, which is why it’s so important to get screened.”

Do liver diseases increase the risk of liver cancer?

Explains Dr. Choi, a chronically inflamed liver creates an environment of constant death and regeneration of liver cells. That incessant stress and cell turnover puts the liver at risk for random genetic mutations that can lead to uncontrolled tumor growth. When you have cirrhosis, for example, the chance of developing hepatocellular carcinoma—HCC, the most common type of liver cancer—is about 5 percent a year.

However, HCC is not a death sentence. “For all intents and purposes,” he says, “HCC is curable. While late recurrences do happen, we often consider a patient ‘cured’ if the cancer has not come back 5 years after treatment.”

What are the main treatments for HBV, HCV and liver cancer?

For both HBV and HCV, the treatment is usually just a single pill once a day, and patients tolerate these medications very well. The difference is that the HBV medicine will likely need to be taken for the rest of your life, while the HCV medicine will only need to be taken for a few months to achieve a cure.

As for HCC—liver cancer—the following treatments can be combined and individualized per the patient’s needs and the nature of the cancer:

• Surgical resection (removal of the tumor and surrounding tissue)
• Locoregional therapies, such as direct ablation using a small needle or embolization of the blood vessels feeding the tumor (both minimially invasive procedures)
• Systemic therapy, including chemotherapy and immunotherapy
• Radiation therapy
• Liver transplantation

“Each of these treatments has its indications, advantages and disadvantages,” Dr. Choi says, “and deciding the best course of action often involves a thorough discussion with your surgeon, radiologist and hepatologist.”

An ounce of prevention

As a liver transplant specialist, Dr. Choi notes that the most common reasons for a liver transplant in the U.S. are alcohol-related liver disease (ARLD) and metabolic-associated fatty liver disease (MAFLD)—also known as fatty liver.

Alcohol use and metabolic syndrome—obesity plus diabetes, high cholesterol and high blood pressure—have been on the rise in our country, and “we are seeing their impact in the liver world,” he says, concluding that adopting a healthier lifestyle can prevent both diseases.

As well, the HBV vaccine should be offered to all infants and children, and to adults who are not immune to the virus.

Dr. Choi also points to several diseases that are not always preventable, such as autoimmune liver disease. “Fortunately,” he says, “most of these diseases can be treated or controlled so that you won’t develop cirrhosis or liver cancer. That’s why screening to diagnose liver disease early is so crucial.

“While a liver transplant can save your life, not needing one in the first place is the best outcome,” he adds.

Liver disease and the Asian community

Of Korean descent and fluent in Korean, Dr. Choi is attuned to the needs of the Asian community in New York City. Certain liver diseases are especially prevalent among Asians, he says, such as HBV. As well, three of his grandparents suffered from the complications of liver disease.

The New York City Department of Health and Mental Hygiene recently published the first comprehensive report on the health of Asians in the city. The study found that Asian adults are twice as likely to be uninsured as whites. More than 60 percent of adult New Yorkers diagnosed with chronic hepatitis B were Asian, and cancer was the number-one cause of Asian deaths overall.

Clearly underserved, the city’s Asian patients also suffer disproportionately from liver disease, including cancer, says Dr. Choi, as they tend to be diagnosed too late; their livers are already failing or their cancers have spread too far.

“New York is home to more than a million Asians,” he continues, “many of whom are either immigrants or children of recent immigrants. As one of the providers in the Asian Liver Health Initiative (ALHI, pronounced ‘ally’), I aim to offer easily accessible, world-class liver care to everyone who may be at risk for liver disease in the community”—a community that has found a champion in Dr. Choi. The city is extremely lucky that he has stepped forward to perform such a vital role.

To search for liver care at Weill Cornell Medicine, visit here. For information on the Asian Liver Health Initiative, visit here.