Hepatitis

Hepatitis is a general term that refers to inflammation of the liver. There are many causes of hepatitis, including infections, medications, toxins, and autoimmune diseases. Of the infectious etiologies, the most common are infections with the hepatitis A [Page 643](HAV), hepatitis B (HBV), and hepatitis C (HCV) viruses. These viruses account for more than 90% of cases of acute viral hepatitis. Acute infection with all three hepatitis viruses can result in similar clinical manifestations, including fever, abdominal pain and loss of appetite, nausea, fatigue, and jaundice. Most cases of acute viral hepatitis resolve spontaneously and carry an excellent prognosis for complete recovery. Less than 0.1% of infected individuals die as a result of acute viral hepatitis. The most common cause of death in the setting of acute viral hepatitis is the development of massive liver necrosis. A possible complication following acute infections with HBV and HCV leads to the development of chronic hepatitis.

It is estimated that there are more than 500,000 new cases of viral hepatitis each year in the United States alone, that more than 1 million Americans are chronically infected with HBV, and that greater than 3 million have chronic HCV infection. Of those individuals with chronic hepatitis, approximately 15,000 will die as a result of complications related to chronic liver disease, such as cirrhosis and hepatocellular carcinoma.

Given the high prevalence of viral hepatitis, athletic individuals are at risk for developing this disorder. Although athletes are much more likely to contract viral hepatitis as a result of activity unrelated to sports, a small risk of disease transmission during sporting activity does exist. Once an individual is diagnosed with viral hepatitis, concerns may be raised regarding the safety of ongoing sports participation. This entry will address the issue of exercise participation in the setting of acute and chronic viral hepatitis, examine the risk of disease transmission during sports participation, and discuss basic strategies to prevent the acquisition of viral hepatitis.

For many years, individuals with acute viral hepatitis were encouraged to avoid physical exertion. Then, studies conducted during the Korean and Vietnam wars, involving soldiers with acute infectious hepatitis, demonstrated that prolonged physical activity restriction was unwarranted. Soldiers who engaged in strenuous exercises once their symptoms became mild had no increased duration of the acute illness, no greater frequency of clinical relapse, and no increased prevalence of chronic liver disease, compared with soldiers who were treated with rest and avoidance of physical activity. A subsequent study involving a small group of patients with acute HBV infection demonstrated the safety of an exercise regimen involving moderate-intensity stationary biking. A joint position statement from the American Medical Society for Sports Medicine and the American Academy of Sports Medicine, published in 1995, recommended that acute HBV infection should be viewed similarly as other viral infections and that an athlete's ability to participate in sports should be based on his or her clinical signs and symptoms such as fatigue, fever, or liver enlargement. Although this publication did not discuss infection with HAV or HCV, there are no data to indicate that infection with these viruses should be managed in a different manner.

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