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Understanding Jaundice: What You Need To Know
When red blood cells die, they leave behind bilirubin, a yellow-orange pigment in the blood. The liver filters bilirubin from the bloodstream to be removed in your stool. If too much is in your system or your liver is overloaded, it causes a buildup known as hyperbilirubinemia. This causes jaundice, where your skin and the whites of your eyes look yellow.
Newborn babies often get it. About 60% have jaundice, also known as icterus, within the first couple of days after birth. Adults can get it, too, although it's less common. See a doctor right away if you think you have jaundice. It could be a symptom of a liver, blood, or gallbladder problem.
If too much bilirubin is left in your system, you can develop hyperbilirubinemia. This can lead to jaundice, which causes your skin and the whites of your eyes to turn yellow. (Photo Credit: Zay Nyi Nyi/Dreamstime)
There are four main types of jaundice, which are grouped by where the bilirubin collects in your body. A blood test can determine which type you have.
Prehepatic
If bilirubin builds up before blood enters the liver, it's known as prehepatic jaundice. This means you're breaking down red blood cells and creating more bilirubin than your liver can process.
Hepatic
If your liver isn't able to process bilirubin well, it's called hepatic jaundice.
Posthepatic
Posthepatic jaundice is when bilirubin builds up after passing through the liver and your body can't clear it quickly enough.
Obstructive jaundice
This condition is when bile isn't able to drain into your intestines because of a blocked or narrow bile or pancreatic duct. This type of jaundice has a high death rate, so it's important to catch and treat it early.
Jaundice may have no symptoms. Any signs you have may depend on how quickly the condition is getting worse. Well-known symptoms are yellowing of the skin and jaundice eyes (also called scleral icterus). But there are others to watch for, including:
How long does jaundice last in adults?
How long jaundice lasts depends on what's causing it and the treatment you need. If a medication is causing it, jaundice will fade after you stop taking it. If hepatitis is causing it, medications can be taken to treat the condition. If there is a blocked bile duct or gallstones, surgery may be required.
Jaundice in adults is rare, but you can get it for many reasons. These include:
Your doctor will ask you about your symptoms and medical history. They'll then give you a physical exam to see if there's swelling in your liver.
To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including:
In adults, jaundice itself usually isn't treated. But your doctor will treat the condition that's causing it.
If you have acute viral hepatitis, jaundice will go away on its own as your liver heals. If a blocked bile duct is to blame, your doctor may suggest surgery to open it. If your skin is itching, your doctor can prescribe cholestyramine to be taken by mouth. This medication is used to remove bile acids from your body, which cause itching.
Phototherapy for jaundice
Phototherapy uses a fluorescent white or blue-spectrum light that breaks down bilirubin so it can be released from the body. This treatment is used for newborns, but phototherapy has not been shown to be effective for treating jaundice in adults.
You may have a higher risk for jaundice if you drink too much alcohol or have hepatitis. It is also more common in people during middle age.
You can reduce your risk of jaundice through lifestyle changes like:
Unlike newborn jaundice, jaundice is not common in adults. It usually goes away on its own, but your doctor may recommend treatment if there is a condition causing it. If you have jaundice symptoms, including yellowish skin or eyes, flu-like symptoms, dark urine, or belly pain, talk to your doctor right away.
Do Two 'Studies' Suggest Hepatitis Linked To Covid-19 Vaccines? Here's What They Really Say
Some social media accounts have been blaming Covid-19 vaccines for the outbreak of acute hepatitis ... [+] across 12 countries. (Photo: Getty)
gettyA mysterious hepatitis outbreak has already affected at least 169 children across 12 countries, as I covered for Forbes on April 26. It's mysterious because its cause has yet to be clearly established. But take a wild guess as to what some on social media have been trying to blame for the outbreak. Here's a hint: it's something that does not turn you into a gigantic magnet and does not make keys stick to your forehead. Yes, anonymous social media accounts have been trying to link the hepatitis outbreak that has left at least one child dead and 17 requiring liver transplants to, drum roll please, Covid-19 vaccines. And some of these accounts along with a website called The Exposé have been citing two "studies," claiming that they serve as evidence.
For example, here's a tweet from an account that calls itself the Donald J. Trump Tracker:
From Twitter
From TwitterAs you can see, this tweet stated that "Madrid's Deputy of Minister for Healthcare and Public Health claim that cases of hepatitis reported on young children might be 'related to the COVID vaccine." Now, this tweet wasn't exactly the pinnacle of grammar. It's not clear who the "Deputy of Minister" is and whether it would be similar to the "Vice of President" of an organization or the "Assistant of Secretary" of a government body. But when you claim that someone said something at least provide the person's real name or a link to the source. You may be tracking Trump but others need to track from where you are getting your information.
Plus, there's one itty bitty problem with blaming Covid-19 vaccines for the hepatitis outbreak. A World Health Organization (WHO) report from April 23 clearly stated that "Hypotheses related to side effects from the Covid-19 vaccines are currently not supported as the vast majority of affected children did not receive Covid-19 vaccination." So how exactly can a child get hepatitis from a Covid-19 vaccine when that child hasn't even gotten a Covid-19 vaccine? That would be like blaming Madonna for making you late to work when you haven't even met Madonna.
So then what about the two so-called "studies" that some have been throwing around? For example, take a look at the following tweet that used a fire emoji and offered a post on the The Exposé:
From Twitter
From TwitterOf note, Science Feedback, a non-profit organization based in France, has called out The Exposé for multiple posts in the past making what they described as false and misleading claims.
The so-called Pizer study referenced in the tweet above was actually something published in Current Issues in Molecular Biology on February 25, 2022, well before the WHO had announced the hepatitis outbreak. All this study showed is that when human liver cells in a test tube are exposed to the components of the Pfizer Covid-19 mRNA vaccine, the liver cells do take up the vaccine components fairly rapidly. Of course, unless you happen to be a giant test tube, this doesn't necessarily mean that when you get the Pfizer Covid-19 vaccine, all of the vaccine components will immediately go to your liver. And just because the vaccine components can enter liver cells doesn't "suggest" that Covid-19 vaccines are to blame for the hepatitis outbreak. For example, you can show that having 50 marmots in you bed can keep you up all night, especially if you have to play parcheesi with them. However, this doesn't necessarily mean that marmots are to blame for the lack of sleep that many Americans have been getting in general.
Then there was this other "new study" offered by a tweet from yet another anonymous social media account and another post on The Exposé:
From Twitter
From TwitterThis so-called study is actually not a formal study but instead a case report published in the Journal of Hepatology on April 21, 2022. The case report described what happened to a 52-year-old male in Germany who developed acute hepatitis two to three weeks after he had gotten the Pfizer Covid-19 mRNA vaccine. Samples of his liver did show evidence of inflammation as well as presence of T cells. T cells, otherwise known as T lymphocytes, are white blood cells that serve various immune protection functions for your body. The presence of T cells did strongly suggest that the man's liver inflammation may have been due to his immune system's response to vaccination against Covid-19. Doctors felt that these findings were "compatible with a probable autoimmune hepatitis" and treated him with oral budesonide and eventually steroids combined with ursodeoxycholic acid. Eventually, within eight weeks, the man's liver enzyme levels returned to normal.
So, yes, this case was evidence that acute hepatitis could potentially be a side effect of the Pfizer Covid-19 mRNA vaccine. Again, though, a key distinction is that this was a case report and not a study. It showed what happened to a single man (in this case, single as in number and not marital status) after getting vaccinated. A case report can't tell you how common or how likely an event may be.
For example, last month I covered for Forbes a case report of a woman who ended up having a glass tumbler lodged in her bladder for four years. Such a rare event doesn't necessarily mean that you should never ever use a glass tumbler again or that you should run screaming anytime anyone tries to pour you a drink. Similarly, a case report or even several reports of acute hepatitis after Covid-19 vaccination shouldn't be reason alone to avoid Covid-19 vaccines. So far, there's no evidence that acute hepatitis is anything more than a potential very rare side effect.
Moreover, all cases of acute hepatitis are not the same. Acute hepatitis is a very broad term for sudden onset inflammation of the liver. The man in the case report survived his bout with acute hepatitis apparently without any permanent damage. This was nowhere near the damage seen among some of the kids being afflicted by the ongoing hepatitis outbreak.
At this point the leading culprit behind the hepatitis outbreak is the type 41 adenovirus, possibly in combination with the severe acute respiratory syndrome coronavirus (SARS-CoV-2), as I described for Forbes previously. Now there are many different types of adenoviruses. While some types are more likely to cause common cold symptoms or respiratory issues, adenovirus type 41 typically spreads via the fecal-oral route (which is a nice way of saying poop-to-mouth). It commonly affects your gut, resulting in gastroenteritis.
The Covid-19 vaccines use different types of adenoviruses with the Astra-Zeneca one using a chimpanzee adenovirus and the Johnson & Johnson vaccine using a Type 26 adenovirus. In both cases, the adenovirus is inactivated so that it can't cause disease. Nevertheless, some anonymous social media accounts have seized upon the whole adenovirus thing, claiming that it is evidence that the adenovirus-based AstraZeneca and Johnson & Johnson Covid-19 vaccines are linked to the hepatitis outbreak:
From Twitter
From TwitterAgain, such claims overlook the itty bitty problem that most of the children being affected by the hepatitis outbreak did not even get the Covid-19 vaccines, whether the vaccines are adenovirus-based or not. This fact would make it difficult for any claims about the Covid-19 vaccines being involved to stick. It would be kind of like trying to get keys to stick on your forehead after you've gotten a Covid-19 vaccine.
A Full List Of Hepatitis C Medications
The most common hepatitis C medications are direct-acting antivirals (DAAs). A typical treatment plan involves a combination of two or more DAAs. In some cases, doctors also combine DAAs with ribavirin or interferons.
The hepatitis C virus (HCV) causes hepatitis C infection and liver inflammation that can lead to liver problems, including cancer.
Chronic hepatitis C needs treatment with medication. Drugs can help ease symptoms and, in many cases, cure the condition.
Even if an HCV infection hasn't caused symptoms yet, treatment is important. This is because medications can lower the risk of complications from hepatitis C, such as liver problems.
HCV has different genetic variations (genotypes). The medication prescribed for hepatitis C depends on the genotype a person has. Genotype 1 is the most common type in the United States.
Here are the medications available to treat hepatitis C, plus some information about what to expect during treatment.
Direct-acting antivirals (DAAs) are the most common treatment for hepatitis C. They're usually taken as pills. These medications can cure hepatitis C in 90–97% of cases. They work by helping to stop HCV from multiplying.
Three types of DAAs are used for hepatitis C. They work on nonstructural (NS) proteins or enzymes to stop HCV from multiplying. These types are:
Different DAA medications are taken in combination with each other to provide effective treatment. Some treatments are available as pills containing two or more drugs.
Doctors may use two other medications in combination with DAAs: ribavirin and interferons.
Each medication type has different benefits, side effects, and risks.
Treatments to cure HCV are not approved for use during pregnancy, according to the Centers for Disease Control and Prevention. If you're pregnant, you can start treatment after your baby is born or once you've finished nursing.
We'll look at each medication type in more detail below.
DAAs are currently the standard of care for chronic HCV infection. These drugs work by attacking HCV directly.
This means they're more targeted than older treatments such as interferons, which are covered below.
Also, DAAs do not affect as many systems in your body as interferons do, so they may not cause as many side effects. Usually, the side effects of DAAs are mild to moderate in severity.
DAAs can cure HCV in more than 90% of cases with 8–24 weeks of treatment.
Side effects of DAAs can include fatigue and headaches.
Less common side effects include:
All DAAs are oral drugs that you swallow. Follow a doctor's or pharmacist's instructions on how to take these medications. They can also tell you what side effects are possible and advise on any symptoms of serious side effects to look out for.
Protease inhibitor antiviral medications (NS3/4A inhibitors)Protease inhibitors can help prevent the spread of infection within your body by stopping viruses from multiplying.
Grazoprevir is a protease inhibitor for hepatitis C genotypes 1 and 4. It's available only in combination with elbasvir and is sold as elbasvir-grazoprevir.
This drug combination is sold under the brand name Zepatier.
NS5A inhibitorsThe action of these drugs isn't fully understood. They may work by stopping the virus from copying itself. They may also help prevent drug resistance (when a drug no longer works to treat a condition).
These drugs can treat all HCV genotypes. They're used alone or in combination with other medications.
Examples of directed inhibitors include ledipasvir (a component of the combination drug Harvoni) and elbasvir (a component of the combination drug Zepatier).
Nucleotide/nucleoside and non-nucleoside polymerase inhibitors (NS5B inhibitors)These drugs work by blocking an enzyme called NS5B. HCV needs this enzyme to replicate itself and survive.
Sofosbuvir (Sovaldi) is an example of an NS5B inhibitor.
All DAAs are given as combinations. Some combinations are available as single pills to make the medication easier to take. Brand names of current combination therapies include:
Doctors use Harvoni, which contains ledipasvir and sofosbuvir, to treat HCV genotype 1. It was approved in 2014.
This medication is available as a tablet or as pellets. You should take this medication at the same time every day.
If you take the pellet form, you can sprinkle the packet of pellets on a small amount of room-temperature or cold food that is non-acidic, such as pudding or mashed potatoes. You must finish eating the combination within 30 minutes. Eat the pellets on soft food so you can avoid a bitter taste released by chewing them.
Zepatier contains elbasvir and grazoprevir. The FDA approved this drug in 2016 to treat HCV genotypes 1 and 4.
Zepatier is available as a tablet. You should take it at the same time every day.
Epclusa, which contains sofosbuvir and velpatasvir, was approved in 2016. It can be used in combination with ribavirin in people with moderate to severe cirrhosis. It's available as a tablet or as pellets.
Epclusa was the first medication to treat all six HCV genotypes.
You should take this medication once every day. If you're taking the pellet form, mix it with a small amount of non-acidic soft food, such as pudding or mashed potatoes. Swallow the mixture without chewing. You should finish eating the mixture within 15 minutes.
The FDA approved Vosevi in 2017 to treat any HCV genotype. It contains the drugs sofosbuvir, velpatasvir, and voxilaprevir.
Vosevi is intended for use when sofosbuvir has not been successful in treating hepatitis C.
This medication is typically taken once every day with food.
The FDA approved Mavyret in 2017 for use in the treatment of any HCV genotype. It contains glecaprevir and pibrentasvir.
Mavyret is the first treatment that can be administered for only 8 weeks in people without cirrhosis. Most of the other combination drugs must be administered for at least 12 weeks.
This medication is available in tablets and pellets. If your doctor prescribes tablets, you'll typically take 3 pills at the same time every day. Mavyret tablets should be taken with food.
Mavyret pellets should be sprinkled onto a spoonful of soft, sticky, low-water food such as peanut butter, thick jam, or cream cheese. Swallow the mixture without chewing. Be sure to finish consuming the mixture within 15 minutes.
Ribavirin works by stopping viruses from replicating and spreading. It's an oral medication that comes in several strengths. It is available in the following forms:
Ribavirin on its own is not an effective treatment option for HCV. Doctors often use it in combination with other drugs to help them be more effective. They typically recommend ribavirin in situations with complicated disease progression or when other treatment regimens have not been successful. The most common brand name for ribavirin is Rebetol.
A doctor or pharmacist will give you instructions for taking ribavirin. You should take it with food. Typically, you'll take it twice a day — once in the morning and once in the evening. It's important to swallow the pills whole. If you're taking liquid ribavirin, shake the bottle well before every use.
Ribavirin can cause fetal development irregularitiesRibavirin may cause fetal development issues if taken before or during pregnancy. It's important to avoid pregnancy while you or your partner is taking ribavirin. And if you are pregnant, you should not have sexual intercourse with a person assigned male at birth who is taking ribavirin.
If you're planning to become pregnant, it's important to wait until after you've stopped taking ribavirin. People assigned female at birth must wait 9 months after stopping ribavirin before starting a pregnancy. People assigned male at birth must wait 6 months after stopping the drug before they attempt pregnancy with a partner.
Other side effects of ribavirinOther side effects of ribavirin may include:
These days, interferons are not commonly used to treat HCV. The newer treatments listed above are typically used instead. This is because interferons can cause a lot of side effects and are not as effective for treating chronic HCV infection.
However, doctors may recommend using this medication alongside DAAs in cases of more complicated disease progression or when other treatment regimens do not work.
Interferon is a protein. It helps your immune system develop an immune response to viruses, including HCV. Peginterferon alfa-2a (Pegasys) is a common brand-name interferon.
Common side effects of interferons include:
More serious side effects can happen over time. These may include:
Peginterferon alfa-2a is an injectable medication. Typically, it's injected once a week into your abdomen or thigh.
As newer, more effective drugs have become available, some older HCV drugs have been discontinued. These include:
Paritaprevir was a drug available only as part of the combination drugs Viekira Pak and Technivie.
Some brand names of ribavirin have also been discontinued. These include:
The current standard of care for hepatitis C involves direct-acting antivirals because they directly attack the virus and have a tolerable side effect profile compared with older treatment options.
The most effective medication with the fewest side effects for hepatitis C may depend on other factors, such as the HCV genotype and your overall health. Doctors may also recommend combinations of medications.
What is the new drug to cure hep C?The FDA approved glecaprevir-pibrentasvir (Mavyret) in 2017 for hepatitis C. Doctors can use it to treat any HCV genotype.
What medication is used to treat hepatitis?Doctors may prescribe different medications to treat hepatitis C, depending on many factors, including your overall health and the HCV genotype you have. In some cases, doctors may recommend multiple medications.
What is the fastest cure for hep C?Glecaprevir-pibrentasvir (Mavyret) can treat hepatitis C in 8 weeks in people without cirrhosis. You typically need to take other hepatitis C medications for 12 weeks.
Hepatitis C can cause unpleasant symptoms and lead to serious health complications.
Your treatment can depend on:
Different types of drugs used to treat hepatitis C work in different ways and can cause unique side effects.
For example, if you have serious kidney disease, you can use only certain HCV treatments. A doctor can talk with you about your options.
If you've ever had hepatitis B, talk with a doctor before starting HCV treatment. Treating HCV can sometimes cause a previous hepatitis B infection to come back.
Ask a doctor which medication might be a good fit for you. Together, you can find the most effective drug to treat your HCV infection with the fewest side effects.
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