By Dr. Kiran Peddi, MRCP (UK), FRCP (Lon), CCT Gastro (UK), Fellowship in Advanced Endoscopy and IBD (Aus)
Senior Consultant Gastroenterologist & Director – Centre for IBD, Yashoda Hospitals, Somajiguda, Hyderabad
Hepatitis B and hepatitis C are viral infections that affect the liver. Both can cause inflammation and, if they become chronic, may lead to serious complications such as liver fibrosis, cirrhosis and liver cancer.
Although they are often discussed together, hepatitis B and C are caused by different viruses and behave differently in the body. They also differ in how they spread, how they can be prevented and how they are treated.
Understanding these differences is important because both infections can remain unnoticed for years. A person may have no obvious symptoms while liver damage is gradually developing.
Hepatitis B and C: What is the difference?
Hepatitis B is caused by the hepatitis B virus (HBV), while hepatitis C is caused by the hepatitis C virus (HCV).
Both can cause an acute infection soon after exposure. In some people, the infection clears naturally. In others, the virus remains in the body and becomes chronic.
One of the major differences is what happens after a chronic infection develops.
Chronic hepatitis B can often be controlled with antiviral medicines, but treatment does not usually eliminate the virus completely. Some patients may need long-term treatment and monitoring.
Hepatitis C is different. Modern direct-acting antiviral medicines can cure most people with hepatitis C, usually with a relatively short course of treatment.
How are hepatitis B and C spread?
The viruses have some overlapping routes of transmission, but there are important differences.
Hepatitis B
Hepatitis B can spread through infected blood and certain body fluids. In India, important routes of transmission include:
- Mother-to-child transmission around the time of childbirth
- Sexual contact with an infected person
- Sharing contaminated needles or equipment
- Accidental needlestick injuries
- Unsafe medical or dental procedures involving contaminated equipment
- Sharing personal items such as razors or toothbrushes when they may be contaminated with blood
A pregnant woman with hepatitis B can pass the infection to her baby during childbirth. This makes screening during pregnancy an important part of prevention.
Hepatitis C
Hepatitis C is mainly spread through exposure to infected blood. This can happen through:
- Sharing needles or injection equipment
- Unsafe injections or medical procedures
- Inadequately sterilised equipment used for tattooing or body piercing
- Accidental exposure to infected blood
- Certain older blood transfusions or blood products, particularly from periods before reliable screening was established
Sexual and mother-to-child transmission of hepatitis C can occur, although blood exposure remains the main route.
Neither hepatitis B nor hepatitis C spreads through ordinary casual contact such as sharing food, hugging or being around someone who coughs or sneezes.
What symptoms should you watch for?
One of the biggest challenges with both infections is that symptoms may be absent, particularly during the early or chronic stages.
When symptoms occur, they can be similar in hepatitis B and C. These may include:
- Persistent tiredness
- Loss of appetite
- Nausea or vomiting
- Pain or discomfort in the upper right side of the abdomen
- Dark urine
- Pale or clay-coloured stools
- Joint pain
- Fever
- Yellowing of the eyes or skin, known as jaundice
Because these symptoms are not specific to hepatitis, they cannot be used to confirm an infection.
Some people only discover that they have hepatitis when they undergo blood tests for another health concern or during routine medical evaluation. This is one reason early testing is important, particularly for people with known risk factors.
Why can hepatitis become a serious liver problem?
The main concern is not always the initial infection but the damage that can occur when the virus remains in the body for years.
Chronic hepatitis can cause ongoing inflammation of the liver. Over time, this may result in fibrosis, where scar tissue develops in the liver. Progressive scarring can lead to cirrhosis, liver failure and an increased risk of liver cancer.
The risk and progression vary between individuals. Factors such as the duration of infection, viral activity, liver health and other medical conditions can influence the outcome.
Hepatitis B can also cause liver cancer in some people even before advanced cirrhosis develops. This is why people with chronic hepatitis B may require regular liver assessment based on their individual risk.
How are hepatitis B and C diagnosed?
Blood tests are central to diagnosing both infections, but the testing process is different.
For hepatitis B, doctors may use a combination of blood markers to determine whether a person has a current infection, has had a previous infection or has immunity. Additional tests such as HBV DNA and liver function tests may be advised depending on the initial results and clinical situation.
For hepatitis C, testing usually starts with an antibody test. If antibodies are detected, an HCV RNA test is used to determine whether the virus is currently present and active.
Testing is particularly important because symptoms alone cannot reliably identify chronic hepatitis.
People with possible exposure, abnormal liver tests, relevant risk factors or other clinical concerns should discuss testing with a doctor. Screening during pregnancy is also important because identifying hepatitis B allows measures to be taken to reduce the risk of transmission to the newborn.
Hepatitis B can be prevented with vaccination
One of the biggest differences between hepatitis B and C is that a vaccine is available for hepatitis B.
Hepatitis B vaccination forms an important part of India’s immunisation programme. Timely vaccination is particularly important for infants because infection acquired early in life is more likely to become chronic.
The birth dose is especially important when the mother has hepatitis B. Depending on the mother’s infection status and medical assessment, additional measures may also be required to protect the newborn.
Adults who have not been vaccinated may also need vaccination depending on their risk and medical advice.
Prevention also involves reducing exposure to infected blood and body fluids. Safe injection practices, proper sterilisation of medical and dental equipment and avoiding the sharing of razors or needles are important measures.
There is no vaccine for hepatitis C
Unlike hepatitis B, there is currently no vaccine that can prevent hepatitis C.
Prevention therefore depends mainly on avoiding exposure to infected blood.
Healthcare facilities must follow appropriate infection-control practices, including safe injection practices and proper sterilisation of reusable equipment. People should also avoid sharing needles, razors or other items that may carry traces of blood.
These measures are particularly relevant in a country like India, where access to healthcare, informal procedures and varying levels of awareness can influence the risk of blood-borne infections.
Treatment: Hepatitis B and C need different approaches
The difference becomes particularly important when it comes to treatment.
Hepatitis B
Not everyone with hepatitis B requires immediate antiviral treatment. Doctors assess factors such as viral activity, liver enzymes, the degree of liver damage and other clinical findings before deciding on treatment.
When treatment is indicated, medicines such as tenofovir or entecavir may be used to suppress the virus and reduce the risk of progressive liver damage.
For many people with chronic hepatitis B, treatment is long term and regular monitoring remains important. The aim is to control the infection, protect the liver and reduce the risk of complications rather than simply treating symptoms.
Hepatitis C
Hepatitis C has a major advantage: it can usually be cured.
Direct-acting antiviral medicines target the virus and can clear hepatitis C from the body in most patients. Treatment commonly lasts around 8 to 12 weeks, although the exact regimen depends on the individual’s clinical situation.
A person is considered cured when the virus remains undetectable in the blood after completing treatment.
However, clearing the virus does not mean a person cannot become infected again. Continued attention to prevention is therefore important if there is ongoing exposure risk.
What if a person has both hepatitis B and C?
It is possible to have both infections at the same time.
This situation requires careful medical assessment because treating one infection can sometimes affect the activity of the other. Before starting hepatitis C treatment, doctors may therefore assess hepatitis B status and monitor appropriately during and after treatment.
The treatment plan should be individualised according to the patient’s viral status, liver health and other medical conditions.
Can lifestyle affect liver health?
Medical treatment is only one part of protecting the liver.
People with chronic hepatitis should avoid alcohol because it can add further stress to an already damaged liver. A balanced diet, maintaining a healthy weight and regular physical activity can also support overall liver health.
Patients should also avoid taking medicines, herbal preparations or nutritional supplements without discussing them with their doctor, particularly if they already have liver disease.
Regular medical follow-up is important even when a person feels well.
The key difference to remember
Hepatitis B and C may look similar at first because both can remain silent and cause long-term liver damage. But their prevention and treatment are different.
Hepatitis B:
- A vaccine is available.
- It can spread through blood and certain body fluids.
- Mother-to-child transmission is an important concern.
- Chronic infection can usually be controlled, but may require long-term treatment and monitoring.
Hepatitis C:
- There is currently no vaccine.
- It is mainly transmitted through infected blood.
- Modern antiviral treatment can cure most infections.
- Treatment is usually completed over a limited period.
Early diagnosis can protect the liver
The most important message is that neither hepatitis B nor hepatitis C should be diagnosed based on symptoms alone.
A person can feel completely healthy while carrying a chronic infection. Testing can identify the infection earlier, allowing doctors to assess the liver and decide whether treatment or monitoring is required.
For hepatitis B, vaccination remains a major tool for prevention. For hepatitis C, safe blood and injection practices are central because no vaccine is available.
Both infections are manageable when identified and appropriately treated. Early diagnosis can reduce the risk of serious liver complications and, importantly, gives patients an opportunity to take action before significant liver damage develops.
Dr. Kiran Peddi is a Senior Consultant Gastroenterologist and Director of the Centre for IBD at Yashoda Hospitals, Somajiguda, Hyderabad, with over 25 years of experience in gastroenterology. He has worked at consultant level across India, the UK and Australia, gaining extensive experience in the management of complex gastrointestinal and liver disorders.
His areas of expertise include the management of simple and complex inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, pancreatic disorders and liver diseases. He also specialises in advanced endoscopic procedures, including Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP).
Dr. Peddi has worked with leading IBD centres in the UK and Australia, including the Intestinal Failure Unit at Hope Hospital and the Centre for IBD in Western Australia. He was also among the early specialists to establish EUS services in the erstwhile United Telugu States.
He is actively involved in medical education and training and has served as an international MRCP examiner for India. He was awarded FRCP (London) for his contributions to medical education and clinical services and played a key role in bringing the MRCP PACES examination centre to Hyderabad.