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Hepatitis
Liver Inflammation: What Type It Is Determines Everything

India carries a significant burden of viral hepatitis across all its forms. Hepatitis A and E are endemic in areas with poor sanitation, causing seasonal outbreaks through contaminated water and food. Hepatitis B affects an estimated 40-50 million people in India, most of whom don't know they're infected. Hepatitis C is prevalent in transfusion recipients and those who underwent medical procedures with inadequately sterilised equipment in past decades. Getting the type right is not just informational: it determines whether someone needs antiviral treatment, whether their household contacts need vaccination, and whether they face a long-term risk of liver damage that requires monitoring.

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Dr. Chhavi Bansal BHMS, Gut Health Specialist HomeoSure
Quick Answer

Hepatitis is inflammation of the liver, most commonly caused by viral infection. Hepatitis A and E are transmitted via contaminated food and water, cause acute (short-term) illness, and resolve on their own without specific treatment; they don't cause chronic liver disease. Hepatitis B and C are transmitted through blood and body fluids (blood transfusion, contaminated needles, mother to child, unprotected sex). They can cause chronic infection that persists for decades, silently damaging the liver before producing symptoms of cirrhosis or liver cancer. Hepatitis B is vaccine-preventable; hepatitis C is now curable with direct-acting antiviral drugs. Both B and C require specific testing to diagnose and staging to guide treatment.

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The Four Hepatitis Viruses: What Each One Means

All four common hepatitis viruses cause liver inflammation, but their routes of transmission, their tendency to become chronic, and their long-term implications are completely different.

Hepatitis A
Spreads via contaminated food and water (faecal-oral route). Causes acute self-limiting illness. Does not become chronic. Full recovery in weeks to months. Vaccine available and effective.
Hepatitis B
Spreads via blood, body fluids, mother-to-child at birth, sexual contact. Can become chronic (especially if infected as infant). Chronic HBV causes cirrhosis and liver cancer over decades. Vaccine available; antiviral treatment can suppress viral replication.
Hepatitis C
Spreads via blood (transfusions, contaminated needles, medical procedures). No vaccine. Becomes chronic in around 70-80% of infected people. Now curable with 8-12 week oral DAA treatment in over 95% of cases.
Hepatitis E
Spreads via contaminated water (faecal-oral route). Usually self-limiting like hepatitis A. Does not typically cause chronic disease in immunocompetent people. Extremely dangerous in pregnancy (up to 25% mortality in third trimester). Common in India during monsoon season and flood conditions.
Hepatitis B in India: The Silent Burden

India has an estimated 40-50 million people with chronic hepatitis B, making it the second-largest burden globally after China. Most are undiagnosed. Many were infected at birth or in early childhood, when the rate of progression to chronic infection is highest. Universal infant hepatitis B vaccination, now part of India's national programme, will reduce future burden significantly, but the existing cohort of infected adults needs testing, staging, and in many cases treatment.

When Hepatitis Becomes a Long-Term Liver Problem

Chronic hepatitis B and C damage the liver through sustained inflammation that, over years and decades, leads to fibrosis (scarring) and eventually cirrhosis (end-stage scarring where normal liver architecture is disrupted). The degree of fibrosis determines prognosis and treatment decisions.

Cirrhosis produces its own complications: portal hypertension (elevated pressure in the hepatic portal vein), leading to oesophageal varices (dilated veins that can bleed catastrophically), ascites, and splenomegaly. Liver synthetic function declines, leading to abnormal clotting, low albumin, and eventually hepatic encephalopathy. Hepatocellular carcinoma (liver cancer) can develop at any stage of fibrosis in hepatitis B and at the cirrhosis stage in hepatitis C.

Fibroscan (transient elastography) is a non-invasive way to assess liver stiffness and therefore fibrosis stage, avoiding the need for liver biopsy in most patients. It is widely available in India and is the preferred first-line tool for staging liver disease in chronic viral hepatitis.

Treatment: Who Needs It and What It Involves

Not everyone with chronic hepatitis B requires antiviral treatment immediately. Treatment decisions are guided by viral load (HBV DNA), liver enzyme levels, fibrosis stage, and age. Those with high viral load, active inflammation, or significant fibrosis benefit most from treatment. Current first-line antivirals for hepatitis B (tenofovir, entecavir) suppress viral replication to undetectable levels in the majority of patients, preventing further liver damage, but usually require long-term or lifelong treatment.

Hepatitis C, by contrast, is now curable. The choice of DAA regimen depends on the HCV genotype (India has predominantly genotypes 1 and 3), presence of cirrhosis, and prior treatment history. Treatment response is monitored by HCV RNA at 12 weeks after completing treatment: undetectable HCV RNA at this point (sustained virological response) represents a cure in the large majority of cases.

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Patient Story

A Real Recovery Story

"

Meena was found to have elevated liver enzymes on a routine blood test done for a health checkup. She had no symptoms. Hepatitis B surface antigen came back positive. Further testing showed she had chronic active hepatitis B with a high viral load. She had been carrying the infection for years without knowing. With appropriate specialist referral and antiviral treatment, her viral load became undetectable, liver enzyme levels normalised, and she is now on long-term monitoring with regular liver ultrasound and AFP to screen for complications. Earlier detection prevents the progression to cirrhosis that would otherwise have followed."

M
Meena S.
Patient · Lucknow · treated at HomeoSure
★★★★★
Common Questions

Frequently Asked Questions: Hepatitis

Acute hepatitis (regardless of type) commonly causes jaundice (yellowing of skin and eyes, dark urine, pale stools), fatigue, nausea, vomiting, right upper abdominal discomfort, and low-grade fever. In hepatitis A and E, these symptoms appear 2-6 weeks after exposure, peak over 1-2 weeks, and gradually resolve. The illness is often more severe in adults than in children for hepatitis A. Hepatitis E can be particularly dangerous in pregnant women, with a mortality rate of up to 25% in the third trimester. Chronic hepatitis B and C are often completely silent for years or decades: the liver is being damaged but produces no symptoms until cirrhosis develops. At that point, symptoms of advanced liver disease appear: ascites (fluid in the abdomen), swollen legs, confusion (hepatic encephalopathy), and jaundice.
Hepatitis B spreads through blood and body fluids: blood transfusion (now rare with blood screening), contaminated needles and syringes (including medical procedures in settings with inadequate sterilisation), unprotected sexual contact, and from infected mother to child during birth (vertical transmission). It does not spread through casual contact, sharing food or water, coughing, or hugging. Hepatitis B is highly vaccine-preventable. The hepatitis B vaccine (three doses over six months) is highly effective, producing protective immunity in over 95 percent of recipients. In India, the hepatitis B vaccine has been part of the universal immunisation programme since 2002. Household and sexual contacts of hepatitis B carriers should be tested and vaccinated if non-immune.
When someone is first infected with hepatitis B (acute infection), most adults (over 95%) clear the virus naturally within six months and develop immunity. A small proportion of adults (around 5%) fail to clear the virus and develop chronic hepatitis B, where the virus persists in the liver long-term. In contrast, when infants and young children are infected (often from their mothers at birth), the rate of chronicity is much higher: around 90% of infected newborns develop chronic infection. Chronic hepatitis B is the concerning form because it can silently damage the liver over decades, leading to cirrhosis and a markedly increased risk of hepatocellular carcinoma (liver cancer). Many people with chronic hepatitis B in India were infected at birth or in early childhood and have no idea they carry the infection.
Yes. Hepatitis C is now effectively curable in the large majority of patients with direct-acting antiviral (DAA) treatments. Modern DAA regimens are 8-12 week oral treatment courses with cure rates (sustained virological response at 12 weeks after treatment) of over 95%. This is a dramatic advance from earlier interferon-based treatments, which were injectable, had significant side effects, and achieved cure rates of 40-60%. The challenge in India is testing: most people with hepatitis C are undiagnosed, particularly those who received blood products or underwent surgical or dental procedures in the 1980s and 1990s. Hepatitis C has no vaccine, so treatment of existing cases is the main way to reduce disease burden.
Yes. Chronic hepatitis B and C are the two leading causes of hepatocellular carcinoma (liver cancer) globally and in India. Chronic hepatitis B carries a 100-fold increased lifetime risk of liver cancer compared to uninfected people, even in the absence of cirrhosis: this is one of the important distinctions from hepatitis C, where cancer risk is closely tied to the presence of cirrhosis. Chronic hepatitis C increases the risk of liver cancer primarily through the cirrhosis pathway. People with chronic hepatitis B or C, particularly those who have developed cirrhosis, require regular surveillance: six-monthly ultrasound and AFP (alpha-fetoprotein) measurement for early detection of hepatocellular carcinoma, when it is still surgically treatable. Antiviral treatment of hepatitis B and C significantly reduces (though does not eliminate) the risk of liver cancer.
Hepatitis A: IgM anti-HAV antibody for acute infection. Hepatitis E: IgM anti-HEV antibody. Hepatitis B: hepatitis B surface antigen (HBsAg) is the primary screening test; if positive, further tests assess the phase of infection (HBeAg, anti-HBe, HBV DNA viral load, liver function tests, liver imaging). Hepatitis C: anti-HCV antibody is the screening test; if positive, HCV RNA confirms active infection (because antibody can remain positive after cleared infection). Liver function tests (including ALT, AST, bilirubin, albumin) assess the degree of liver inflammation and function. Fibroscan or liver biopsy can assess the degree of liver fibrosis in chronic infection. Testing should be done for anyone with jaundice, elevated liver enzymes, risk factors for hepatitis B or C, or a household member with confirmed infection.

Jaundice, liver enzyme elevation, or hepatitis risk factors?

Chronic hepatitis B and C are treatable conditions that benefit from early identification and staging. If you have risk factors or have been told your liver enzymes are elevated, a structured assessment and appropriate testing can clarify what's happening and what's needed.

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