Transmission of viral hepatitis has been a recognized complication of transfusion therapy with factor VIII and IX replacement products since the 1970s.
Hepatitis A Virus
Signs and Symptoms: Jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever.
Long-Term Effects: HAV infection is self- limiting; there is no chronic infection. Once a patient has been infected, he or she is immune from the virus. About 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6- to 9-month period.
Transmission: HAV is found in the stool (feces) of people with HAV and usually spread by putting something in the mouth that has been contaminated with the stool of a person with HAV.
Hepatitis B Virus
Signs and Symptoms: Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and joint pain. 30% of people with HBV have no signs or symptoms.
Long-Term Effects: Chronic infection among 90% of infants who are infected at birth; 30% of children infected ages 1-5 years; 6% after age 5 years. Death from chronic liver disease in 15%-25% of chronically infected persons.
Transmission: HBV is spread by having sex with an infected person without using a condom, sharing drugs or needles, needlesticks or sharps exposure on the job, or from an infected mother to her baby during birth.
Hepatitis C Virus
Signs and Symptoms: Jaundice, fatigue, dark urine, abdominal pain, loss of appetite, nausea. 80% of people with HCV have no signs or symptoms.
Long-Term Effects: Chronic infection among 55% to 85% of infected people. Chronic liver disease among 70% of chronically infected persons, with 1% to 5% succumbing to the disease.
Transmission: HCV transmission occurs when blood from an infected person enters the body of a person who is not infected. It is spread through intravenous drug use and sharing needles, as well as needlesticks or sharps injuries on the job. It may also be spread from an infected mother to her baby during birth.
Hepatitis D Virus
Signs and Symptoms: Jaundice, fatigue, dark urine, abdominal pain, loss of appetite, nausea, vomiting, and joint pain.
Long-Term Effects: HDV can be acquired either as a coinfection with HBV, or a superinfection among patients with existing chronic HBV infection. People with HBV-HDV coinfection can have more severe, acute disease and higher risk (2% to 20%) of developing acute liver failure, compared with those infected with HBV alone.
Transmission: same as those for HBV.
Among those in the bleeding disorders community, HCV infects more people and crosses a larger age span than HIV. The emotional reactions to HCV infection are similar to those for HIV, and include denial, fear, and anxiety. Today, patients and their families can benefit from increased support and education from HTC staff to help them assess the risks and benefits of treatment, cope with the potential side effects of treatment, and deal with the uncertainties related to the disease. Those who are coinfected with HIV often experience heightened concerns about mortality because the medications they take for HIV can cause liver disease to progress. Patients with a history of depression should be evaluated for treatment with antidepressants or adjustments in dosage prior to starting HCV medications. All patients undergoing HCV treatment should be closely monitored for changes in their psychosocial status and offered increased support as needed.