India carries a substantial share of the global hepatitis B and C burden, and the majority of those infected do not know. Both viruses can persist for decades without symptoms while quietly damaging the liver.
Both are now manageable, and hepatitis C is curable in the great majority of people, which was not the case a decade ago.
How They Differ From Hepatitis A and E
The letters cause confusion, and the distinction is important.
Hepatitis A and E spread through contaminated food and water. They cause acute illness with jaundice, and almost always resolve completely without becoming chronic. Hepatitis E is dangerous in pregnancy, where it carries significant mortality.
Hepatitis B and C spread through blood and body fluids. They frequently become chronic, persisting for decades and causing cirrhosis and liver cancer.
This article concerns B and C, because those are the ones that require testing and long term management.
How They Spread
Transmission routes overlap but differ in emphasis.
Hepatitis B: mother to child at birth, which is the most common route in India, unsafe injections and blood products, unsterile tattooing, piercing or shaving equipment, sexual contact, and sharing razors or toothbrushes.
Hepatitis C: primarily blood exposure, through unsafe injections and reused needles, transfusions before screening was introduced, unsterile medical or dental equipment, and injecting drug use. Sexual and mother to child transmission occur but are less efficient than with B.
Neither spreads through sharing food, hugging, coughing, mosquitoes or casual contact. This matters, because people diagnosed with hepatitis B in India frequently face social exclusion based on incorrect beliefs.
Why There Are Usually No Symptoms
Chronic hepatitis typically causes nothing noticeable for years or decades. The liver has considerable reserve and continues functioning while damage accumulates.
Where symptoms appear they are non specific: fatigue, mild discomfort under the right ribs, poor appetite. Jaundice, abdominal swelling, vomiting blood and confusion appear only at the cirrhosis stage.
This is why testing rather than waiting for symptoms is the only way to find these infections in time to prevent damage.
Who Should Be Tested
Testing is inexpensive and should be considered far more widely than it currently is.
- Anyone who has never been tested, at least once in adult life
- All pregnant women, which is standard antenatal practice
- Family members and sexual partners of an infected person
- Anyone who received a blood transfusion before routine screening
- People with tattoos or piercings from non sterile settings
- Healthcare workers
- People with raised liver enzymes or unexplained liver findings
- People with HIV
- Anyone who has injected drugs
- Patients on dialysis
Screening tests are HBsAg for hepatitis B and anti HCV antibody for hepatitis C, available through our laboratory.
Hepatitis B: Management
Not everyone with chronic hepatitis B needs treatment. Assessment determines which phase of infection you are in.
Evaluation includes HBeAg status, viral load, liver enzymes, and assessment of fibrosis by elastography or blood based scores. Some patients are in an inactive carrier state with minimal liver activity and need monitoring rather than drugs.
Where treatment is indicated, oral antiviral tablets suppress the virus effectively with few side effects. They control rather than cure, so treatment is generally long term. Stopping without advice can cause a dangerous flare.
Everyone with chronic hepatitis B needs regular surveillance for liver cancer, typically ultrasound every six months, because cancer can develop even without cirrhosis.
Hepatitis C Is Now Curable
This is the most significant change in liver medicine in recent decades and it is still not widely known among patients.
Direct acting antiviral tablets cure over ninety five percent of patients with a course of eight to twelve weeks. Side effects are mild, injections are not required, and the older interferon based treatment with its severe side effects is obsolete.
A positive antibody test means exposure, not necessarily current infection, since some people clear the virus naturally. A confirmatory HCV RNA test establishes whether the virus is still present.
Cure is defined as undetectable virus twelve weeks after finishing treatment. Once cured, the virus does not return, though reinfection is possible with fresh exposure. Generic versions produced in India have made these treatments far more affordable than when first launched.
Preventing Hepatitis B
Hepatitis B is vaccine preventable, and the vaccine is highly effective.
- Birth dose within twenty four hours, followed by the schedule in infancy, which is part of routine immunisation
- Catch up vaccination for unvaccinated adults, three doses over six months
- Vaccination strongly recommended for healthcare workers, family contacts of infected people, dialysis patients and people with multiple partners
- Babies born to infected mothers need both vaccine and immunoglobulin within twelve hours of birth, which prevents transmission in the great majority
That last point is important. Mother to child transmission is the main route in India and it is almost entirely preventable with correct management at birth, which is why antenatal screening matters.
There is no vaccine for hepatitis C, so prevention relies on safe injection practice and sterile equipment.
Living With Chronic Hepatitis
A diagnosis is not a reason to withdraw from normal life, and the social stigma attached to it in India is largely unfounded.
- Avoid alcohol entirely, since it accelerates liver damage substantially
- Maintain a healthy weight, as fatty liver alongside hepatitis worsens outcomes
- Get vaccinated against hepatitis A if not immune
- Check with a doctor before taking any new medicine or herbal supplement
- Attend surveillance appointments even when feeling well
- Do not share razors, toothbrushes or nail clippers
- Inform healthcare providers, including dentists
You can work, marry, have children and share meals normally. Family members should be tested and vaccinated rather than avoided.
If you have never been tested for hepatitis B and C, do it once. Both infections are silent, both are treatable, and hepatitis C is curable with a short course of tablets. Vaccination protects against B for you and your family.
Our gastroenterology department at T. Nagar provides hepatitis testing, treatment and liver surveillance.
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