Key points
- Hepatitis C is curable in the large majority of patients with 8–12 weeks of oral antiviral tablets (DAAs).
- Hepatitis B is controlled, not usually cured: tenofovir or entecavir suppress the virus and greatly reduce the risk of cirrhosis and cancer, but must not be stopped without advice.
- A safe, effective vaccine prevents hepatitis B; family members and sexual partners of a person with hepatitis B should be tested and vaccinated.
- Anyone with cirrhosis from hepatitis B or C — and some hepatitis B patients without cirrhosis — needs six-monthly ultrasound for liver cancer.
- Liver transplant works well for hepatitis B and C, with antiviral medicines to prevent the virus returning in the new liver.
Hepatitis B and C at a glance
| Hepatitis B | Hepatitis C | |
|---|---|---|
| How it spreads | Mother to baby at birth, blood, unsafe injections, sexual contact, sharing razors or toothbrushes | Mainly blood: unsafe injections, older blood transfusions, dialysis, tattoos with unsterile needles, shared injecting equipment |
| Not spread by | Sharing food, water, utensils, hugging or breastfeeding (with vaccination of the baby) | Casual contact, food, water or utensils |
| First test | HBsAg | Anti-HCV antibody, confirmed with HCV RNA |
| Treatment | Tenofovir or entecavir, usually long-term | 8–12 weeks of direct-acting antiviral tablets |
| Can it be cured? | Rarely eliminated; well controlled with treatment | Yes, in the large majority |
| Vaccine | Yes, highly effective | No vaccine; reinfection possible after cure |
Testing: what the reports mean
- HBsAg positive means hepatitis B virus is present. If it stays positive beyond six months, the infection is chronic. Further tests — HBeAg, HBV DNA (viral load), ALT and a FibroScan — decide whether treatment is needed now.
- Anti-HCV positive means exposure to hepatitis C at some time. It does not by itself mean current infection; an HCV RNA test confirms whether the virus is active.
- Everyone with hepatitis B or C should also be assessed for liver scarring (blood scores, FibroScan, ultrasound), tested for the other hepatitis viruses and HIV, and checked for hepatitis D if they have hepatitis B.
Before chemotherapy, steroids or biologic drugs
Anyone about to start chemotherapy, long-term steroids or other immune-suppressing treatment should be tested for hepatitis B first. A silent infection can flare dangerously during such treatment; preventive antiviral tablets avoid this.
Antiviral treatment
Hepatitis C: direct-acting antivirals (DAAs), such as combinations containing sofosbuvir, are taken by mouth for 8–12 weeks and cure the infection in the large majority of patients, including many with cirrhosis. Cure is confirmed by a negative HCV RNA test 12 weeks after finishing. Side effects are usually mild. India's national viral hepatitis programme offers free testing and treatment at designated centres.
Hepatitis B: not everyone with hepatitis B needs treatment immediately. Treatment is advised when the viral load and liver enzymes are raised, when there is significant fibrosis or cirrhosis, during certain stages of pregnancy, before immune-suppressing therapy, and in some people with a family history of liver cancer. Tenofovir or entecavir — one tablet a day — suppresses the virus in almost everyone who takes it regularly.
Never stop hepatitis B tablets on your own
Stopping tenofovir or entecavir without medical advice can cause a severe flare of hepatitis, which can lead to liver failure. Take the tablet every day, keep a supply in hand when travelling, and have blood tests as advised.
Vaccination and family screening
- 1
Test the household
When one person has hepatitis B, their spouse or partner, children, parents and siblings should be tested for HBsAg and for immunity. Hepatitis C is less often spread within families, but sexual partners and children of infected mothers should be tested.
- 2
Vaccinate those who are not protected
The hepatitis B vaccine is usually given as three doses over six months. It is part of India's childhood immunisation schedule, and adults who were never vaccinated should be.
- 3
Protect newborns
A mother with hepatitis B should tell her obstetrician. Her baby needs the hepatitis B vaccine within 24 hours of birth, together with hepatitis B immunoglobulin; mothers with a high viral load may be given antiviral tablets in late pregnancy.
- 4
Everyday precautions
Do not share razors, toothbrushes or nail clippers; cover cuts; use condoms until a partner is confirmed immune; and never donate blood.
Cirrhosis and liver cancer risk
Untreated, a proportion of people with chronic hepatitis B or C develop cirrhosis over 20–30 years, faster with alcohol, diabetes, fatty liver or co-infection with another virus. Both viruses raise the risk of hepatocellular carcinoma. Hepatitis B is notable because it can cause liver cancer even without cirrhosis.
Successful treatment lowers but does not remove this risk once cirrhosis has developed. People with cirrhosis — even after hepatitis C cure — and certain higher-risk people with hepatitis B need an ultrasound every six months, often with an AFP blood test. Cancers found at this stage may be treatable with liver cancer surgery or transplant.
Go to hospital urgently if a person with hepatitis B or C develops:
deepening jaundice, confusion or drowsiness, vomiting blood or black stools, a rapidly swelling abdomen, or severe weakness and vomiting — particularly after stopping antiviral tablets or starting chemotherapy. These can signal a flare that may progress to liver failure.
Liver transplant for hepatitis B and C
A liver transplant is considered for hepatitis B or C when cirrhosis has decompensated, when a hepatitis B flare causes acute or acute-on-chronic liver failure, or when liver cancer develops within transplant criteria. See liver transplant evaluation for how suitability is assessed.
- Hepatitis B: before transplant, the viral load is suppressed with antivirals. After transplant, lifelong antiviral tablets — with hepatitis B immunoglobulin in some protocols — make recurrence in the new liver uncommon.
- Hepatitis C: DAAs can be given before transplant, or after it once the patient is stable. Recurrence in the new liver, once a major problem, is now curable with the same tablets.
A living donor who is HBsAg-positive or has active hepatitis C would not usually be accepted; donors with markers of past hepatitis B exposure may be acceptable with preventive treatment for the recipient. Dr Bappaditya Har performs living donor and deceased donor liver transplants at Narayana RN Tagore Hospital, Mukundapur, Kolkata. Families from Bangladesh and eastern India can share hepatitis reports on WhatsApp (+91 70420 39420) before travelling.
Frequently asked questions
Can hepatitis B be cured completely?
In most adults with chronic hepatitis B, the virus is controlled rather than eliminated. Long-term tablets keep it suppressed and protect the liver. A small number lose HBsAg over time, which is considered a functional cure.
How long is hepatitis C treatment?
Usually 8 to 12 weeks of tablets, occasionally longer in people with advanced cirrhosis or previous treatment failure. Cure is confirmed by a negative HCV RNA test 12 weeks after finishing.
Can a woman with hepatitis B have a normal pregnancy and breastfeed?
Yes. With a birth dose of vaccine and immunoglobulin for the baby, and antiviral tablets for the mother if her viral load is high, transmission to the baby is largely prevented. Breastfeeding is generally considered safe.
Can I get hepatitis C again after cure?
Yes. Cure does not give immunity, so re-exposure through unsafe injections or blood can cause a new infection. There is no vaccine for hepatitis C.
Do I need a transplant for hepatitis B?
Most people with hepatitis B never need a transplant, especially if treated before cirrhosis. A transplant is considered only for liver failure or liver cancer within treatable limits.
Can a family member with hepatitis B donate part of their liver?
A person who currently has hepatitis B (HBsAg positive) is not usually accepted as a donor. Someone with only markers of past infection may be. The transplant team decides after testing — see who can be a liver donor.
Related reading
Liver Cirrhosis Treatment in Kolkata: Stages, Care and When to Consider a Transplant →
Cirrhosis explained: compensated vs decompensated, Child-Pugh and MELD in plain words, what treatment can and cannot do, and when to consider a transplant.
Liver Cancer Surgery →
Surgery and transplant for hepatocellular carcinoma and liver tumours.
Liver Transplant Evaluation: Who Needs It, MELD Scores and the Tests →
Who needs a liver transplant, what MELD and PELD scores mean, the tests in a transplant work-up, reasons transplant may not be possible, and what to bring.
Liver Specialist in Kolkata: Hepatologist, Gastroenterologist or Liver Surgeon? →
Hepatologist, gastroenterologist or liver transplant surgeon? Which liver doctor in Kolkata to see for fatty liver, hepatitis, cirrhosis or a tumour.
Liver Transplant in Kolkata for Patients from Bangladesh →
A practical guide for Bangladeshi families planning a liver transplant in Kolkata: sending reports, medical visas, donor papers, stay and follow-up.
This page is general patient information, not a diagnosis or a substitute for a consultation. Treatment decisions depend on each patient's reports and examination. Read our medical disclaimer and editorial policy.