Hepatitis B and C — What You Need to Know

Some of the most worrying patients I see are the ones who feel completely well. They come in for a routine check-up or a pre-surgery screen, and the report shows a positive hepatitis result. Hepatitis B and hepatitis C often stay silent for years while quietly damaging the liver.

The good news is that both infections are now far easier to manage than they used to be, and one of them can be cured.

What are hepatitis B and C?

Both are viral infections that cause inflammation of the liver. Hepatitis B is caused by the hepatitis B virus (HBV), a DNA virus. Hepatitis C is caused by the hepatitis C virus (HCV), an RNA virus.

Either can cause a short-lived acute illness or a long-term chronic infection. Chronic infection is the real problem, because over the years it can lead to cirrhosis, liver failure, and hepatocellular carcinoma. The World Health Organization estimates that hundreds of millions of people live with chronic hepatitis B or C worldwide, and most do not know it.

How do they spread?

Hepatitis B spreads through contact with infected blood and body fluids. The common routes are mother-to-child transmission at birth, unprotected sex, sharing needles, and exposure to contaminated medical or dental equipment. In many high-prevalence regions, transmission during birth or early childhood is the leading cause.

Hepatitis C spreads mainly through blood. Sharing needles, unsterilized medical or dental instruments, unscreened blood transfusions, and unsafe injections are the main risks. Sexual and mother-to-child transmission can occur but are less common.

Neither virus spreads through hugging, coughing, sneezing, or sharing food and utensils.

Symptoms

Most people have no symptoms at first, particularly with hepatitis C. When symptoms do appear, they include:

• Fatigue and general weakness
• Nausea, poor appetite, and vague upper abdominal discomfort
• Dark urine and pale stools
• Jaundice (yellowing of the skin and eyes)
• Joint pain

In advanced disease, patients may develop abdominal swelling (ascites), leg edema, easy bruising, or confusion. These point to decompensated cirrhosis and need urgent attention.

How are they diagnosed?

Hepatitis B

Diagnosis starts with serology. HBsAg (hepatitis B surface antigen) is the key screening test, and a positive result means active infection. Anti-HBc and anti-HBs help determine whether the infection is acute, chronic, resolved, or whether the person is immune through vaccination. HBV DNA by PCR measures the viral load and guides the decision to start treatment.

Hepatitis C

Screening is done with an anti-HCV antibody test. Antibodies can stay positive after the virus has cleared, so a positive result must be confirmed with HCV RNA by PCR to prove current infection. Genotype testing is sometimes done, although modern pan-genotypic regimens have made it less critical.

Liver function tests, ultrasound, and a fibrosis assessment (such as FibroScan or FIB-4 score) then show how much liver damage has already occurred.

Treatment

Hepatitis B: Acute infection usually needs only supportive care. For chronic disease, long-term oral antivirals such as tenofovir or entecavir suppress the virus, slow liver damage, and lower the risk of cirrhosis and liver cancer. These drugs control hepatitis B rather than cure it, so treatment is often long-term. Pegylated interferon is an option for selected patients.

Hepatitis C: This is where treatment has changed most. Direct-acting antivirals (DAAs), for example sofosbuvir-based regimens, are taken for about 8 to 12 weeks and cure more than 95% of patients. Success is confirmed by an undetectable HCV RNA 12 weeks after finishing treatment.

Prevention

• Get the hepatitis B vaccine. It is safe, effective, and given to newborns, children, and at-risk adults.
• Pregnant women should be screened for HBsAg so that newborns receive the vaccine and immunoglobulin promptly if needed.
• There is no vaccine for hepatitis C, so prevention depends on safe injections, sterilized equipment, and screened blood.
• Never share needles, razors, or toothbrushes.
• Use barrier protection during sex with new or unknown partners.
• Get screened if you have had surgery, dental work, or injections in settings with poor infection control.

A simple blood test can change the course of your liver health. If you have never been tested, ask your doctor about screening.