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PATHOLOGY PERSPECTIVES Two of the unique features of the hepatitis B virus are its stability outside of a host, and its high concentration in the blood. This means that it can last on surfaces for many hours, and it can be transmitted with very minimal contact: a shared toothbrush or razor may be all that it takes. Used hypodermic needles, tattoo equipment, or piercing equipment are also possible vectors. Hepatitis B can also be spread through other intimate fluids, including semen and vaginal secretions. About 5 percent of all hepatitis B patients develop a chronic version of this infection, with continued communicability and a risk of severe liver damage. For this reason, it is important to treat hepatitis B; interferon, lamuvidine, and ribovarin are the typical recommendations. hePaTITIS C From the early 1970s to 1989, epidemiologists knew that a third liver- loving virus was becoming common, and they called it "hepatitis non-A, non-B." (Now we have identified hepatitises C, D, E, F, and G, although D–G are not considered threatening.) Hepatitis C is an extremely slow- acting virus. Because the liver can easily compensate for lost function, several years or even decades can pass between exposure and the development of symptoms. Hepatitis C appears to be most communicable by direct blood-to-blood contact. This includes contaminated transfusions or organ transplants, shared needles, or contaminated tattoo or piercing equipment. There is some controversy about whether hepatitis C can be spread through unprotected sex; this appears to be an efficient mechanism only when there is significant tearing of mucous membranes. Blood tests for hepatitis C are accurate within a few months of exposure, so it can be diagnosed long before symptoms begin. Hepatitis C is treated with drugs that limit viral activity, specifically interferon, ribivarin, and some other medications that can improve the prognosis for this infection, but they carry a long list of side effects. One of the most serious concerns with hepatitis C is that only about a quarter of the people who are infected can expect to recover without treatment. In other words, 2011. www.who.int/mediacentre/factsheets/fs328/en/index.html. "hepatitis a FaQs for health Professionals." Centers for disease Control and RESOURCES "hepatitis a." Fact sheet number 328. WhO 2011. accessed September 2011. www.who.int/mediacentre/factsheets/fs204/en/index.html. "hepatitis B FaQs for health Professionals." Centers for disease Control and Prevention. accessed September 2011. www.cdc.gov/hepatitis/hav/havfaq.htm. "hepatitis B." Fact sheet number 204. WhO 2011. accessed September Prevention. accessed September 2011. www.cdc.gov/hepatitis/hBv/hBvfaq.htm. "hepatitis C." Fact sheet number 204. WhO 2011. accessed September 2011. www.who.int/mediacentre/factsheets/fs164/en/index.html. "hepatitis C FaQs for health Professionals." Centers for disease Control and on hepatitis a and B in kids." medscape Infectious diseases, Webmd. accessed September 2011. www.medscape.com/viewarticle/743651?src=mp&spon=17. Prevention. accessed September 2011. www.cdc.gov/hepatitis/hCv/hCvfaq.htm. jhaveri, R. "What's new in the alphabet Soup of viral hepatitis: an update 75 percent of people with hepatitis C are at risk for being communicable throughout their life, and for developing serious liver problems. Story 1: "One of my clients is a fisherman. He told me in the middle of his last session that he had just tested positive for hepatitis C. That was when I noticed that his hands were covered with little nicks and cuts, and my own hands weren't perfect either. That week, I went to the health department to be tested, and it turns out that I am also positive for hepatitis C. Is it possible that I caught it from this client?" Truthfully the answer to this question is almost certainly not. It is most likely that this therapist was exposed many years ago. But our job is to reduce the risk of spreading this virus throughout our environment to as close to zero as possible, and we do that by following good hygienic practices. HEPATITIS COMPLICATIONS The consequences of viral attacks against the liver are related to progressive loss of function. Here is a short list of complications: • Jaundice. If the liver is impeded in making bile, bilirubin backs up through the body, staining the skin, and mucous membranes, yellow. • Excessive bleeding. Clotting proteins cannot be produced by a damaged liver, so the potential for bruising or bleeding becomes a serious problem. • Ascites. When the liver is clogged with scar tissue, fluid seeps from the major blood vessels into the abdominal cavity. Because this fluid is essentially stagnant, it becomes vulnerable to spontaneous infection and life-threatening peritonitis. • Sexual dysfunction. When liver function is impaired, men may develop feminizing characteristics (enlarged breasts, atrophied genitals), and women may develop masculinizing characteristics (excessive body hair, loss of the menstrual cycle). 102 massage & bodywork november/december 2011