Hepatitis B & C — Diagnosis & Treatment
India has approximately 4 crore people with chronic Hepatitis B and 1.2 crore with Hepatitis C — together causing 2.5 lakh liver-related deaths annually. Hepatitis B vaccine has been part of India's Universal Immunization Programme since 2011, while Hepatitis C is now curable with 12-week Direct-Acting Antiviral (DAA) regimens.
Hepatitis B (HBV — DNA virus) and Hepatitis C (HCV — RNA virus) are transmitted through blood and body fluids — sexual, blood transfusion, contaminated needles, needle-stick, vertical (mother-to-child). Both cause acute hepatitis (often asymptomatic) and chronic infection. Chronic infection leads to cirrhosis (20-30% over 20-30 years) and hepatocellular carcinoma (HCC).
India has intermediate HBV endemicity (3-5% chronic carriers) and low-moderate HCV prevalence (1-2%). Vertical transmission is the major route for HBV in high-endemic countries. Iatrogenic transmission (unsafe injections, blood transfusion) remains significant for both.
Serological markers:
| Marker | Meaning |
|---|---|
| HBsAg (Surface antigen) | Active infection (acute or chronic). Positivity > 6 months = chronic |
| Anti-HBs (Surface antibody) | Immunity — from vaccination or resolved infection |
| Anti-HBc (Core antibody) | Total = past or current infection; IgM = acute infection |
| HBeAg (e antigen) | High viral replication, high infectivity |
| Anti-HBe | Low viral replication, lower infectivity (seroconversion) |
| HBV DNA | Viral load — for monitoring treatment response |
Common patterns: Vaccinated (anti-HBs+ alone); Resolved infection (anti-HBs+ + anti-HBc total+); Acute infection (HBsAg+ + anti-HBc IgM+); Chronic infection (HBsAg+ > 6 months); Inactive carrier (HBsAg+ + anti-HBe+ + low HBV DNA + normal ALT).
Treatment (chronic HBV): Indications — HBV DNA > 2000 IU/mL + ALT elevated, OR cirrhosis with detectable HBV DNA. First-line drugs: Tenofovir 300 mg OD OR Entecavir 0.5 mg OD (1 mg if decompensated). Lamivudine avoided (high resistance). Pegylated Interferon-alpha (limited role, contraindicated in decompensated cirrhosis). Treatment is usually lifelong — stopping can cause flare. HCC surveillance with ultrasound +/- AFP every 6 months in cirrhotics.
Diagnosis:
- Anti-HCV antibody — screening test. Positive = exposure (does not distinguish current vs resolved infection)
- HCV RNA (PCR) — confirms active infection. Detectable = current infection
- HCV genotype — guides treatment duration and drug choice. India: genotype 3 (50-60%), genotype 1 (25-30%) most common
Treatment (HCV — curable): Direct-Acting Antivirals (DAAs) — cure rate > 95%. Regimens (pan-genotypic, India's National Viral Hepatitis Control Programme):
- Sofosbuvir 400 mg + Velpatasvir 100 mg OD x 12 weeks — pan-genotypic, no cirrhosis
- Sofosbuvir + Velpatasvir + Voxilaprevir x 12 weeks — for salvage after DAA failure
- Sofosbuvir + Daclatasvir OD x 12 weeks — alternative pan-genotypic
- Cirrhosis: add Ribavirin (weight-based) and extend to 24 weeks if decompensated
No vaccination available for HCV — prevention through safe blood, safe injections, harm reduction for PWID.
- HBV vaccination: Birth dose within 24 hours + 3 doses at 6, 10, 14 weeks (pentavalent). Healthcare workers, dialysis patients, household contacts of carriers, high-risk groups also vaccinated
- Post-exposure prophylaxis (HBV): Needle-stick from HBsAg+ source — give HBIG (hepatitis B immunoglobulin) 0.06 mL/kg IM within 24 hours + vaccine booster if not immunised
- Perinatal HBV prevention: Birth dose within 24 hours + HBIG if mother HBsAg+ (high-risk vertical transmission)
- Safe blood: Mandatory HBsAg and anti-HCV screening of all donated blood
- Safe injections: Auto-disable syringes, no reuse
- Harm reduction for PWID: Needle exchange, opioid substitution therapy
- National Viral Hepatitis Control Programme (NVHCP): Launched 2018 — free HBV vaccination (birth dose), free HBV and HCV testing and treatment at district level
Hepatitis B is preventable by vaccine and treatable with lifelong antivirals; Hepatitis C is curable with 12 weeks of DAAs. For UPSC CMS aspirants, HBV serology interpretation, HBV vaccination birth dose, and HCV DAA regimens are highly testable topics.