Hepatitis B and C

Both, hepatitis B and hepatitis C infections begin as short-term infections (acute) but in some people, the virus remains in the body that leads to a lifelong (chronic) infection.

• Chronic hepatitis B and C infections are more serious and can lead to considerable liver damage and scarring (cirrhosis) or liver cancer
• Risk for chronic infection is related to age at infection
  • About 90% of infected infants with hepatitis B will become chronically infected, while only 2%–6% of adults will have the chronic form
  • About 75%–85% of people who become infected with hepatitis C virus will develop a chronic infection

Risk factors

• Having mucosal contact with infectious blood, semen, and other body fluids
• Sexual transmission
• Sharing contaminated needles to inject drugs
• Getting a tattoo in unregulated settings
• Sharing shaving blades
• From an infected mother to her newborn during delivery
• Patients on hemodialysis

Symptoms

• At time of exposure
  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Body ache
  • Dull Abdominal pain
• After 1-2 weeks
  • Dark yellow urine
  • Yellowish discoloration of eyes
  • Clay-colored bowel movements

Investigations

Blood tests can detect the presence of Hepatitis B or Hepatitis C and then stage the infection

Hepatitis B

• Hepatitis B surface antigen (HBsAg) will indicate the presence (positive test) or absence (negative test) in acute or chronic infection
• In Window period, IgM anti HBc can only be positive indicating acute infection
• Further blood testing is required such as HBV DNA quantification (by PCR method) to determine viral load in blood stream along with some more antigen and antibody tests in case of a positive screening test
• People with chronic hepatitis B should also be screened for lesions in liver by USG abdomen for cancer surveillance at time of first presentation and then 6 monthly once subsequently.
• If detected during pregnancy, then it is important to check the viral load. Then start treatment from middle of second trimester till delivery to reduce the viral load, so that transmission does not happen to newborn baby. Type of delivery is as per obstetrician discretion. Breast feeding not contraindicated. Also important to vaccinate the newborn against hepatitis B immediately after delivery

Hepatitis C

• Hepatitis C antibody test can indicate if hepatitis C virus has been present in the past
• Hepatitis C virus RNA test can indicate if a current infection with the hepatitis C virus is present

The results will present as:

• Non-reactive (negative) test, which means that a person has never had hepatitis C. However, if a person has been recently exposed to the hepatitis C virus, he or she will need to be tested again.
• Reactive (positive) test, which means that hepatitis C virus has been present at some point in time. A reactive antibody test does not necessarily mean a person has hepatitis C. Once someone has been infected, they will always have antibodies in their blood. This is true even if they have cleared the hepatitis C virus.

A reactive antibody test requires an additional test, called a hepatitis C virus RNA quantification test (by PCR method), to confirm whether the virus is still present in the person’s bloodstream and if yes, how much load is present.

Treatment

Hepatitis B

• Acute infection
  • Since 85-90% patients clear the virus in acute stage, no medicine is required.
  • Rest, proper nutrition, and fluids are recommended
  • Some people may need to be hospitalized if there is persistent nausea and vomiting.
  • Jaundice is self - limiting and will settle in next 4 – 6 weeks.
  • Complementary or alternative medicines not recommended
• Chronic infection
  • Should seek the care or consultation of a doctor, especially a liver specialist
  • Regular monitoring for signs of liver disease and evaluation may be necessary
  • Several medications have been approved for hepatitis B treatment; new drugs are in development
  • Not all persons need treatment, but once a person starts treatment, he or she will need to take medication for life
  • Hepatitis B is one of the most important causes of development of liver cancer. Hence if detected, it is important to stage the infection and initiate treatment to prevent further liver damage, halt any progression to cirrhosis and most importantly, reduce the risk of liver cancer
  • All family members of the patient should be screened for hepatitis B mandatorily and vaccinated immediately if negative
• Prevention of hepatitis B by taking vaccination should be mandatory as prevention is always better than cure

Hepatitis C

• Acute infection
  • Since 75-85% patients clear the virus in acute stage, no medicine is required.
  • Rest, proper nutrition, and fluids are recommended
  • Some people may need to be hospitalized if there is persistent nausea and vomiting.
  • Jaundice is self-limiting and will settle in next 4 – 6 weeks.
  • Complementary or alternative medicines not recommended
• Chronic infection
  • Present treatment of chronic hepatitis C is safe and extremely effective with 90 – 95% cure rate.
  • Depending on the clinical setting, the duration of treatment maybe 3 – 6 months.
  • Early detection and treatment prevents further liver damage and progression to cirrhosis and liver cancer.
  • All family members of the patient should be screened for hepatitis C mandatorily and start treatment if detected infection
  • At present, no vaccination is available to prevent hepatitis C.
  • Patient with hepatitis C and liver cirrhosis should be screened for liver cancer at periodic intervals as there is a continued risk of liver cancer even after hepatitis C virus infection is cured.
  • Patients should be vaccinated against hepatitis A and hepatitis B
  • Persons with chronic hepatitis C should avoid alcohol because it can cause additional liver damage

Enquire Now at Gleneagles Global, Lakdikapul, Department of HPB surgery & Liver Transplant, for liver related issues like Hepatitis B and C.

Dr Chandan Kumar KN

Senior Consultant - Hepatology & Lead Transplant Physician

Gleneagles Global Hospital Lakdikapul

Disclaimer:The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.