Hepatatis B and C

 Introduction

Viral hepatitis, particularly Hepatitis B (HBV) and Hepatitis C (HCV), remains a major global health problem. These viruses cause both acute and chronic liver disease, leading to complications such as cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Globally, millions live with chronic infection, many are undiagnosed, and treatment and prevention remain unevenly available. This article explores both, comparing and contrasting their biology, epidemiology, clinical features, diagnosis, treatment, prevention, and current challenges & innovations.

Hepatitis B (HBV)

Virology & Pathogenesis

HBV is a DNA virus from the Hepadnaviridae family. It infects hepatocytes and establishes a stable form of DNA (cccDNA) in the nucleus, allowing persistent infection. The immune response, rather than the virus itself, causes most of the liver damage.

Epidemiology

Over 254 million people globally are chronically infected.

Transmission is mostly perinatal in high-endemic areas, and through sexual or parenteral routes elsewhere.

Highest prevalence is in sub-Saharan Africa and East Asia.

Clinical Features

Acute HBV: 

Often asymptomatic. Symptoms, if present, include fatigue, nausea, jaundice.

Chronic HBV:

 May progress to cirrhosis or HCC, especially with high viral load and coinfections.

Diagnosis

HBsAg:

 Indicates current infection.

Anti-HBs:

 Indicates immunity (via recovery or vaccination).

HBV DNA: 

Measures viral replication.

Liver function tests, imaging, and non-invasive fibrosis scores guide management.

Treatment

Nucleos(t)ide analogues: 

Tenofovir, Entecavir are first-line drugs.

Pegylated Interferon: 

Shorter course, but less tolerable.

Treatment usually long-term and aims to suppress viral replication.

Prevention

Vaccine: 

Highly effective. Birth-dose plus routine schedule recommended.

Mother-to-child transmission: 

Preventable with timely birth-dose and maternal antiviral therapy.

Safe medical practices and blood screening are crucial.

Challenges

Low diagnosis and treatment rates.

High cost of antiviral therapy in some countries.

No true cure yet (due to persistent cccDNA).

Hepatitis C (HCV)

Virology & Pathogenesis

HCV is a single-stranded RNA virus in the Flaviviridae family. It replicates rapidly and mutates frequently, allowing chronic infection in 55–85% of cases.

Epidemiology

Estimated 50 million people chronically infected globally.

Primarily transmitted via blood exposure (e.g., IV drug use, unscreened transfusions).

No vaccine is available.

Clinical Features

Acute HCV: 

Usually asymptomatic.

Chronic HCV: 

Can progress to liver fibrosis, cirrhosis, and HCC over decades.

Extrahepatic manifestations include cryoglobulinemia, glomerulonephritis, and insulin resistance.

Diagnosis

Anti-HCV antibody:

 Initial screening.

HCV RNA: 

Confirms active infection.

Genotype testing:

 Sometimes used to guide therapy.

Assessment of liver damage by elastography or fibrosis scores.

Treatment

Direct-acting antivirals (DAAs): 8–12 week oral regimens, >95% cure rates.

Pan-genotypic regimens: Like sofosbuvir/velpatasvir, simplify treatment.

Prevention

Blood safety, safe injections, and harm reduction.

No vaccine available yet.

Treating and curing chronic carriers helps reduce transmission.

Challenges

High cost of DAAs in some regions.

Limited access to testing and care.

Reinfection risk in high-risk populations.

Comparative Table: 

HBV vs HCV

Feature HBV HCV

Virus type DNA RNA

Vaccine Yes No

Chronicity Higher in infants Lower but still high

Cure available Rare (functional cure) Yes (DAAs)

Transmission Sexual, perinatal, blood Mostly blood

Treatment duration Often lifelong 8–12 weeks

Elimination strategy Vaccine + treatment Treatment-focused

Public Health & Global Impact

Underdiagnosis: 

Most people with HBV/HCV are unaware.

Burden of disease: 

Hepatitis is a leading cause of liver cancer and liver transplants globally.

Stigma and inequality: 

Affects testing, diagnosis, and access to care.

Economic costs:

 High for both health systems and affected individuals.

Recent Guidelines (2024)

WHO HBV Guidelines: Lowered treatment thresholds, especially in people with fibrosis or elevated ALT. Expanded maternal prophylaxis.

Point-of-care diagnostics:

 Encouraged for both HBV and HCV to simplify access.

HCV elimination plans: 

Encourage mass testing and treatment in high-risk populations.

Case Examples

Pakistan: 

High HBV and HCV burden. Poor vaccination coverage and unsafe medical practices contribute.

Egypt: 

Successfully scaled up HCV testing and treatment, a global model.

Sub-Saharan Africa:

 Urgent need for birth-dose HBV vaccination scale-up.

Future Directions

HBV Cure Research:

 New drug classes like capsid inhibitors, RNA interference therapies.

HCV Vaccine Development: 

Ongoing, but difficult due to virus diversity.

Integration into primary care: 

Helps normalize testing and reduce stigma.

Targeted strategies: 

For high-risk populations like PWID, pregnant women, and prisoners.

Summary & Conclusion

Hepatitis B and C continue to challenge global health systems. Despite effective vaccines (for HBV) and curative treatments (for HCV), most people remain undiagnosed and untreated. To achieve WHO’s elimination targets by 2030, we need:

Wider access to diagnosis and treatment

Strong political commitment

Affordable medications and vaccines

Public awareness and education campaigns

Integrated, patient-friendly health systems