Hepatitis is a disease that causes inflammation in the liver. Viral hepatitis may be caused by the hepatitis A, B, C, D, or E viruses (with A, B, and C being the most common). Chronic viral hepatitis can lead to cirrhosis (scarring and dysfunction of the liver), liver cancer, liver failure, and death.
The doctors at the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center are experts in the care of patients with viral hepatitis, and are especially renowned for pioneering new approaches to the treatment of hepatitis C (HCV). Patients receive the full range of care, including personalized medical therapy with the latest medications and monitoring.
NewYork-Presbyterian physicians have directed and participated in major studies that led to the development of the standard HCV therapies used today, as well as those evaluating investigational drugs and new treatment regimens for patients with HCV. NewYork-Presbyterian's Center for Liver Disease and Transplantation excels in providing liver transplantation to patients with HCV and has more clinical experience caring for these patients than most hospitals.
Types of Viral Hepatitis
Hepatitis B (HBV) is a blood-borne microorganism transmitted by exposure to the hepatitis B virus through infectious body fluids. About 1.4 million Americans have chronic hepatitis B infection, and about 350 million individuals worldwide have this disease. However, since many HBV infections do not cause symptoms or not reported, the number of people infected with HBV is likely to be higher.
Hepatitis C (once called non-A, non-B hepatitis) is a liver disease caused by a blood-borne virus discovered in 1989. Approximately 4.1 million Americans, or 1.6 percent of the population, are infected with HCV, and of these, about 3.2 million are chronically infected. New infections have declined from about 240,000 per year in the 1980s to approximately 16,000 annually in 2009.
About a third of those infected with HBV have no symptoms. Symptoms in other individuals may include jaundice (yellowish tint to skin and/or eyes), fever, fatigue, nausea, vomiting, loss of appetite, abdominal pain, dark-colored urine, light-colored stools, and joint pain. Many patients with chronic HBV infection have no symptoms until they are diagnosed with cirrhosis or end-stage liver disease.
Many people who are chronically infected with HCV do not have any symptoms, and may have normal blood tests. Others may experience fever, fatigue, nausea, lack of appetite, mild upper-right abdominal pain or discomfort, or diarrhea. Individuals with more advanced disease may have jaundice, light-colored stools, or darker urine.
Patients whose hepatitis has caused cirrhosis may experience fatigue, weakness, itching, dark urine, fluid buildup in the legs (edema) or abdomen (ascites), nausea, and reduced appetite.
Viral Hepatitis Diagnosis
A blood test can determine whether patients are infected with hepatitis B or hepatitis C by detecting certain antigens and antibodies in a patient's blood. These antigens and antibodies can reveal if the virus is present and whether an individual is acutely or chronically infected. Blood tests may also be performed to examine a patient's liver enzymes.
In some patients, our physicians may perform a computed tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or liver biopsy (removal and examination of a sample of liver tissue) to further assess liver damage.
Hepatitis B Prevention and Treatment
Hepatitis B can be prevented through vaccination. While there is no treatment for acute HBV infection, chronic infection can be treated with antiviral drugs. Individuals with chronic HBV infection need to be assessed regularly to determine whether the disease is progressing, and to determine whether the liver is damaged.
Hepatitis C Treatment
Unlike hepatitis B, there is no vaccine currently available to prevent hepatitis C.
The standard treatment for HCV has been a combination of the antiviral drug ribavirin with pegylated interferon (a type of interferon designed to remain in the body longer). Depending on the subtype of HCV, treatment may last 24 or 48 weeks. Our physicians monitor patients with HCV regularly with blood tests and sometimes liver biopsy.
Interferon is associated with significant side effects, however. About 40 percent of patients require a reduction in their interferon dose because of severe side effects, and about 15 percent stop treatment, diminishing its effectiveness.
In 2011, the field of HCV care was boosted with the approval by the U.S. Food and Drug Administration of two new drugs: boceprevir and telaprevir. CADC physicians were leaders in the clinical trials that ultimately led to the approval of these drugs, which are known as "protease inhibitors." Another protease inhibitor, simeprevir, was approved in November 2013. Each of these drugs, when given in combination with ribavirin and pegylated interferon, can actually cure patients of HCV infection.
CADC physicians also led or participated in clinical trials of the drug sofosbuvir, which belongs to a class of drugs called "nucleotide polymerase inhibitors." Sofosbuvir was approved by the FDA in December 2013. It is used in combination with other antiviral drugs. Some patients can take sofosbuvir and ribavirin without the need for interferon. These studies represent a new model for HCV management and have the potential to change the standard of care for this challenging viral infection.
Hepatitis B and Hepatitis C Research
CADC investigators continue to lead studies of new treatments for HBV and highly promising targeted HCV agents, including interferon-free regimens. Patients who come to the CADC for their hepatitis care may have opportunities to participate in these clinical trials.
NewYork-Presbyterian also participates in the Center for the Study of Hepatitis C, a collaborative research and treatment partnership comprised of physicians and researchers from Weill Cornell Medical College, The Rockefeller University, and NewYork-Presbyterian Hospital.