Signs And Symptoms

Signs and Symptoms

Initial infection with HBV or HCV may cause acute symptomatic disease, but many patients will be asymptomatic.^1,2

If symptoms do occur, they will be similar regardless of the type of hepatitis. The only definitive way to determine the type of viral infection is to carry out serological analyses.³

• When they occur, symptoms of acute HBV or HCV infection may include:^3–6
  • fever
  • fatigue
  • decreased appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • grey-coloured faeces
  • joint pain
  • jaundice
• Since infection with hepatitis viruses are often asymptomatic, PLWHIV should receive appropriate screening.⁵ Refer to the diagnostic tools section for more details.

Hepatitis B

• In the general population:
  • The HBV incubation period ranges from 30–180 days, with an average of 90 days⁶
    • HBV may be detected 30–60 days after infection, and can persist for widely variable periods of time
  • HBV can survive outside the body for about a week, and can cause infection during this time⁶
  • As with asymptomatic acute HBV, patients with chronic hepatitis B may not feel unwell for decades after becoming infected¹
    • development of symptoms may indicate advanced liver disease in a chronically-infected individual⁴
  • 15–40% of patients with chronic HBV infection will develop serious consequences during their lifetime⁷
• HBV-HIV co-infected patients frequently have higher HBV DNA levels, more severe hepatic disease and increased rates of liver-related mortality than those infected with HBV alone⁷
  • in HBV-HIV co-infected patients, liver enzyme levels (eg. alanine aminotransferase [ALT] levels), used as a measure of hepatic inflammation, may not be elevated despite severe disease⁸

Hepatitis C

• In the general population:
  • The HCV incubation period ranges from 14–180 days, with an average of 45 days³
  • Estimates suggest that acute HCV infection is asymptomatic in 50–90% of cases²
  • Chronic infection occurs in 55–85% of infected individuals³
    • most people who become chronically infected with HCV have no knowledge of their infection or of the ensuing long-term hepatic damage²
    • 70% of individuals with chronic HCV infection develop chronic liver disease³
• Progression of liver disease is accelerated in HCV-HIV co-infected people compared with HCV infected individuals who are HIV-negative²

Hepatitis-related liver damage

Serum/plasma characteristics that could indicate potential viral hepatitis-related liver damage include:

• serum fibrosis markers, or combinations of markers, including hyaluronic acid, Fibrotest, Fibrometer, Hepascore, the aspartate aminotransferase (AST) to platelet ratio index (APRI), the FIB-4 index, the Forns index and other indices⁵
  • tests such as Fibrometer, Fibrotest and Hepascore may predict liver fibrosis more accurately than simple biochemical tests such as APRI, FIB-4 or Forns⁵

Markers of hepatic function may perform well in the detection of significant fibrosis, but they do not perform as well in the detection of lesser degrees of fibrosis

• the combination of multiple markers improves accuracy for detecting fibrosis²
• markers of hepatic synthetic function that could indicate potential viral hepatitis-related liver damage include:^5,9
  • coagulation tests
  • serum albumin concentrations <3.4 g/dL
  • serum cholinesterase test (CHE), where pseudocholinesterase levels <8 U/mL may indicate liver damage
• other markers of liver function that could indicate potential viral hepatitis-related liver damage include:⁹
  • alkaline phosphatase (ALP) serum concentrations >147 IU/L
  • elevated alanine aminotransferase (ALT) levels compared with age- and gender- matched averages
  • serum AST concentrations >34 IU/L
  • gamma-glutamyltransferase (GGT) serum concentrations >51 IU/L
  • total serum bilirubin levels >1.9 mg/dL

For information on HBV and HCV screening, refer to the diagnostic tools page. 

References

1. World Health Organization (WHO). Introduction of hepatitis B vaccine into childhood immunization services. Management Guidelines, Including Information for Health Workers and Parents. Accessed 2 December 2011.
2. European Association for the Study of the Liver (EASL). Clinical practice guidelines: management of hepatitis C virus infection. J Hepatol 2011;55:245–264. Accessed 1 December 2011.
3. Immunization Action Coalition. Hepatitis A, B and C: Learn the differences. Accessed 1 February 2012.
4. World Health Organization (WHO). Hepatitis C: Factsheet 164.  Accessed 1 December 2011.
5. European AIDS Clinical Society (EACS). Guidelines Version 6.0. Accessed 30 November 2011.
6. World Health Organization (WHO). Hepatitis B: Factsheet 204.  Accessed 1 December 2011.
7. American Association for the Study of Liver Diseases (AASLD). Practice Guideline. Chronic Hepatitis B: Update 2009. Accessed 1 December 2011.
8. Peters MG. Diagnosis and management of hepatitis B virus and HIV coinfection. Top HIV Med 2007;15:163–166. 
9. US National Library of Medicine and National Institutes of Health. Medline Plus: Liver Function Tests. Accessed 2 December 2011.