Managing viral Hepatitis B and C
Dr Sanjiv Saigal
Worldwide, 296 million people are living with Hepatitis B while 58 million people are living with hepatitis C. India has approximately 40 million chronically infected individuals with hepatitis B, constituting 3-4% of population prevalence. The population prevalence of Hepatitis C in India is approximately 1%.
Common causes of hepatitis
Viral hepatitis caused due to hepatitis B and C are among the most common causes of hepatitis. Other important causes of hepatitis include Alcohol & Non-Alcoholic fatty Liver disease. Drug induced hepatitis is also an important cause of hepatitis in India.
Mode of spread of hepatitis B and C
Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment, or from mother to baby at birth. Hepatitis B and Hepatitis C have similar modes of transmission.
Early and late symptoms of hepatitis
Not all people with acute HBV infection have symptoms. Most children <5 years of age and newly infected immunosuppressed adults are generally asymptomatic, whereas 30%–50% of people age ≥5 years have signs and symptoms. When present, signs and symptoms of acute HBV infections can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stool, joint pain and jaundice. Some patients of chronic hepatitis B can develop cirrhosis or hepatocellular carcinoma over long term.
Similarly, the majority of newly infected persons with hepatitis C may remain asymptomatic. Many people eventually develop chronic liver disease after several years, which can range from mild to severe and include cirrhosis (scarring of the liver) and liver cancer.
Diagnosis of Hepatitis B and C
There are some blood tests which can easily detect hepatitis B and hepatitis C infection. These basic screening test are HbsAg and Anti-HCV .Among those who are infected, viral load testing is done to assess the magnitude of infection. Some patients will need further testing such as Ultrasound, Fibroscan, CT scan or MRI and Endoscopy to further evaluate the magnitude of liver disease.
Treatment of Hepatitis B and C
People with acute hepatitis B infection are provided supportive treatment depending on their symptoms. For people with chronic infection, several highly effective antiviral medications are available (such as Entecavir & Tenofovir).
Treatment for Hepatitis C is recommended for all people with detectable HCV RNA. Currently available antiviral drugs for hepatitis C are highly effective with a cure rate of over 95%
For prevention of viral hepatitis it is important to avoid coming in contact with blood or bodily fluids of others which can be done by avoiding sharing personal items, such as razors or tooth brushes, not sharing drug needles or other drug equipment. One must be careful when getting tattoos and body piercings & ensuring safe sexual practices. Highly effective vaccine is available for Hepatitis B and all infants should be vaccinated for Hepatitis B. Vaccine for Hepatitis C is not yet available. Awareness about Hepatitis B and C should be our topmost priority.
(The author is Principal Director and Head, Hepatology and Liver Transplant Medicine, Max Hospital Saket, New Delhi)