1. Definitions
1. What is acute hepatitis ?
2. What is chronic hepatitis ?
3. What is cirrhosis ?
2. Lab Tests
1. What are transaminases (AST and ALT) ?
2. What is PCR (the DNA or RNA) ?
3. What does HBsAg positive mean ?
4. What does HBcAb (or anti-HBc) positive mean ?
5. What does "anti-HCV positive" mean ?
3. Transmission
1. How are hepatitis B, C and G transmitted ?
2. Which tests should be performed after an exposure to hepatitis viruses ?
4. Vaccination
1. Should patients with chronic hepatitis receive vaccination against other viral hepatitis ?

1) What is acute hepatitis ?
It's an inflammation of the liver that last for a short period. It can recover or persist, becoming a chronic hepatitis, according to the cause of the disease. Acute viral hepatitis B and C frequently becomes chronic.

2) What is chronic hepatitis ?
It's an inflammation of the liver that persist for more than 6 months. It causes a continuous liver damage that can lead, after some years, to cirrhosis (scarring of the liver). Therapy can stop or delay evolution of chronic hepatitis, therefore it's important its early diagnosis, before cirrhosis occurs.

3) What is cirrhosis ?
It is an irreversible disease characterized by scarring of the liver. Cirrhosis is caused by a chronic liver injury (chronic viral hepatitis, alcohol abuse, etc.) that progressively destroys liver cells, which are replaced by scar tissue. It is a serious condition that causes reduction of liver functions and increases risk of develop liver cancer.

1) What are transaminases (AST and ALT) ?
They are enzymes located into hepatocytes so, when liver cells are damaged or die, transaminases are released into bloodstream, where they can be measured. They are therefore an index of liver injury.

2) What is PCR (the DNA or RNA test) ?
It is a blood test used to detect viral genome (HBV DNA or HCV RNA) in bloodstream. It is very sensible and can detect the virus also if it's present in very low amount. This test can also be used to assess the amount of virus in blood (viral load).
It's used to confirm :

• diagnosis of chronic hepatitis B or C when transaminases are in normal range (test is positive)
• recovery after therapy (test is negative)
• early diagnosis of infection after exposure to the virus (it becomes positive within 2 weeks from infection)

4) What does HBcAb (or anti-HBc) positive mean ?
It means that you have been infected with HBV (this test remains negative after vaccination). This test don't tell you if virus is still present or not. If virus is still present also HBsAg is positive and transaminases can be increased.

5) What does "anti-HCV positive" mean ?
It means that you have had a previous contact with hepatitis virus C (HCV). Nevertheless this test cannot confirm if the virus is still present in your body. Only PCR, another blood test, can do it.
Therefore if you are anti-HCV positive and want to know if you have hepatitis C at the present time, you need to perform HCV-RNA PCR. This test can be:

• Negative (virus is absent and hepatitis is recovered)
• Positive (virus is present and causes an hepatitis C)

1) How are hepatitis B, C and G transmitted ?
These viruses are blood-borne pathogens, therefore transmission occurs through infected blood or other body fluids that may contain blood (saliva, urine, menstrual fluid, semen) or items contamined by blood (needles, blades, razors, etc.).
Sexual transmission is more frequent for hepatitis B than in hepatitis C. Hepatitis B can also be transmitted from mother to baby during delivery.

2) Which tests should be performed after an exposure to hepatitis viruses ?
After infection and before symptoms occur (incubation period) some blood tests can be performed to assess if infection has occurred or not.
Transaminases (AST and ALT) raise when an hepatitis is present, but give no information about the type of hepatitis (only hepatitis markers can do it). This is a simple test, that can be performed in any laboratory. It's not expensive and results are ready after few day. Transaminases should be tested at least 3-4 weeks after exposure and should be evaluated at least twice, waiting a month between tests. If they remain in normal range infection is not occurred. It's important to avoid the consumption of alcohol and medications for a week before the test, because they can raise transaminases.
More specific is PCR. This test is available for hepatitis B (HBV-DNA PCR) and C (HCV-RNA PCR) and can be performed after only 2 weeks fron exposure. It's positive if virus is present. Nevertheless this test is expensive, is not performed in all laboratory and requires 3-4 weeks to have the results.

Should patients with chronic hepatitis receive vaccination against other viral hepatitis ?
Yes, because these patients are at increased risk for acute liver failure (fulminant hepatitis), a severe form of infection that may
lead to death. Patients with chronic hepatitis B can be vaccinated only against hepatitis A, whereas patients with chronic hepatitis C can be vaccinated also against hepatitis B.