Risk factors
Hepatitis A is more common among people who:
- they work or travel in countries where the disease is widespread, even if they stay in luxury hotels;
- they have unprotected sexual relations of a proctogenital or ano-lingual nature (especially male homosexuals);
- they injected drugs or shared the syringe together with others (especially drug addicts);
- they use non-injectable drugs (the risk is lower than in the previous point, but we must consider that drug addiction is often accompanied by poor personal hygiene standards and that drugs can be hidden in the intestinal tract or contaminated in another way);
- contract closely with infected individuals (kindergartens, schools, family members, etc.);
- they consume raw or insufficiently cooked seafood.
Food behaviors at risk for hepatitis A
- Consume raw seafood
- Consume raw frozen berries
- Consume raw fruits and vegetables NOT washed
- Drinking well water
In industrialized countries like ours, the sanitary improvements have considerably reduced the incidence of hepatitis A, but primary prevention remains very important.
Diagnosis
Hepatitis A infection can easily be unmasked by a simple blood test, even in the absence of symptoms.
After collection, the plasma concentration of bilirubin and transaminases (which rise in the presence of liver damage, regardless of whether it was induced or not by HVA) is evaluated.
To obtain a significant datum, specific antibodies against hepatitis A must be searched in the blood sample. Since these appear in the blood only after weeks or even months from the infection, performing the anti-HAV immunoglobulin monitoring in early age involves a high number of false negatives (people who, despite being sick, appear healthy in light of the results provided by the test). Likewise, the risk of false positives should not be underestimated, since the antibodies continue to be present in the blood even when the infection has resolved.
For this reason, the diagnosis is based mainly on the search for anti-HAV IgM antibodies, which appear early and disappear just as quickly after a few months; anti-HAV IgG antibodies, on the other hand, appear during the convalescence phase and remain throughout life. As a result, IgM antibodies represent a marker of acute infection, while IgG testify to a previous exposure to hepatitis A virus and immunity to it.
Complications
In principle, the severity of the disease is directly proportional to the age of the infected person. Fortunately, the infection is generally self-limiting, meaning that the liver heals completely, usually within one or two months, without suffering permanent damage.
The elderly and people who suffer from debilitating diseases, such as anemia, diabetes or heart problems, are more exposed to relapses and need a longer time to recover.
The most serious complication of hepatitis A, although extremely rare, is fulminant hepatitis. This is a very serious condition that causes liver failure and can seriously endanger the patient's survival. The risk is greater for people with an already suffering liver due to certain pathologies (other forms of hepatitis) or the abuse of alcohol or certain drugs.
As mentioned, this virus does not appear to play a role in inducing chronic active hepatitis or cirrhosis.
Care and treatment
The best cure for hepatitis A is prevention. No specific treatment is available against HAV, except for the early administration of standard gamma globulin (antibodies) within 7-14 days of infection. Consequently, if the symptoms have already appeared, this path is no longer viable and we only monitor the progression of the disease, which, in the vast majority of cases, regresses spontaneously.
In order not to further stress a liver already tested by infection, the patient is often asked to follow some simple dietary guidelines. First of all, the daily caloric amount is divided into many small snacks. At the same time, the consumption of too fatty foods, especially if fried or singed, will be reduced in favor of easily digestible dishes, such as broth, soups, yogurt, fruit and vegetables. Imperative is the removal of alcohol, at least until complete remission of symptoms.
In the presence of hepatitis A it is important to tell your doctor about all the medicines you are taking, including over-the-counter products for headaches or menstrual pain. In fact, some of these can produce liver-toxic metabolites.
Specific supplements, such as artichoke extracts, milk thistle and silymarin, provide important help, thanks to their ability to purify the liver of toxins and improve its functionality. Their use in the presence of hepatitis A must however take place under medical supervision, since, a bit like all phytotherapeutic products, they are contraindicated in the presence of certain diseases and could interact with some drugs prescribed to the patient.
If the disease becomes complicated in fulminant hepatitis, medical admission is required, necessary to face any emergencies promptly and to provide the patient with special dietary and pharmacological treatments. The most complicated cases may require liver transplantation, in a desperate attempt to save the patient's life.
