Hepatitis B and C: Testing, Monitoring and Treatment

Liver health

Patient education · Reviewed by the treating clinician · Last reviewed January 2026

Hepatitis B and hepatitis C are viral infections that inflame the liver. Both are common in India, both can become chronic, and both are far more manageable than most people realise when they are first diagnosed. Hepatitis C can now be cured in the great majority of people in about two to three months of tablets. Hepatitis B is usually controllable with long-term medication and monitoring.

How they are transmitted

Both viruses spread through contact with infected blood and, for hepatitis B, other body fluids.

• Blood. Transfusion of unscreened blood, shared needles or syringes, unsterile tattooing or piercing, sharing razors or toothbrushes, needlestick injuries in healthcare settings.
• Medical and dental procedures with inadequately sterilised instruments.
• Mother to child. Important for hepatitis B, and preventable by vaccinating the newborn within hours of birth.
• Sexual transmission. More relevant for hepatitis B than for hepatitis C.

Neither virus spreads by casual contact. Sharing food, using the same utensils, hugging, coughing, sneezing or using the same toilet do not transmit hepatitis B or C. Stigma around these infections is unfounded and does real harm — it discourages testing, and untreated infection is far more dangerous than the infection itself.

Acute and chronic infection

Both viruses can cause an acute infection, with fatigue, nausea, poor appetite, jaundice, dark urine and abdominal discomfort. Many people, however, notice nothing at all.

• Hepatitis C: about three-quarters of people who are infected do not clear the virus and go on to develop chronic infection.
• Hepatitis B: whether the infection becomes chronic depends largely on age at infection. Infection in infancy or early childhood very often becomes chronic, whereas infection in adulthood is cleared by most people.

Chronic infection may cause no symptoms for many years while continuing to damage the liver. That is why monitoring matters even when you feel well.

What the tests mean

Hepatitis B: monitoring, treatment and why it is long term

Not everyone with hepatitis B needs medication immediately. The decision depends on viral load, liver enzyme levels, the degree of fibrosis, age, family history of liver cancer, and whether there is cirrhosis. Some people are monitored for years without treatment; others need antiviral tablets promptly.

Where treatment is started, oral antiviral medicines are usually taken once daily for the long term. They suppress the virus effectively and reduce the risk of progression to cirrhosis and liver cancer. They usually do not eliminate the virus completely, which is why treatment and monitoring continue rather than stopping after a fixed course.

Follow-up for chronic hepatitis B usually includes:

• Regular blood tests for liver function and viral load.
• Periodic FibroScan or other fibrosis assessment.
• Six-monthly liver ultrasound surveillance for liver cancer if cirrhosis or significant fibrosis is present.
• Screening of family members and sexual partners, and vaccination of those who are not immune.
• Vaccination against hepatitis A, and against other infections as advised.

Hepatitis C: why this is genuinely good news

Direct-acting antiviral (DAA) tablets have changed hepatitis C from a difficult, poorly tolerated interferon-based treatment into a short course of oral tablets. Treatment typically lasts 8–12 weeks, with cure rates above 90% in most patient groups. Cure means the virus is no longer detectable about twelve weeks after finishing treatment.

The usual steps are:

1. Confirm current infection with HCV RNA testing.
2. Assess the liver with blood tests and FibroScan, because fibrosis stage determines follow-up afterwards.
3. Check for interactions with your existing medicines — genuinely important with DAAs.
4. Take the tablets as prescribed for the full course; it is short but must be completed.
5. Test for cure twelve weeks after completing treatment.

Importantly, cure does not reverse established cirrhosis, so if cirrhosis was already present, liver cancer surveillance and variceal screening continue after cure. If fibrosis was mild, the risk falls substantially and follow-up becomes much lighter.

Who should be tested

• Anyone diagnosed with abnormal liver function tests of uncertain cause.
• People who received blood products or had surgery, particularly before screening was routine.
• Household and sexual contacts of someone with hepatitis B or C.
• Children born to a mother with hepatitis B.
• Anyone with a tattoo or piercing done with unsterile equipment.
• Patients on dialysis, and healthcare workers with occupational exposure.

Prevention

• Hepatitis B is vaccine-preventable. The vaccine is safe and effective, recommended for all infants and for unvaccinated adults at risk, and given as a three-dose schedule.
• There is no vaccine for hepatitis C, so prevention relies on avoiding exposure to infected blood.
• Use sterile needles and equipment for any medical, dental, tattooing or piercing procedure.
• Do not share razors, toothbrushes, nail clippers or any item that may carry blood.

The bottom line

If you have been diagnosed with hepatitis B or C, the most important thing you can do is attend regular follow-up rather than waiting for symptoms. Chronic viral hepatitis usually causes no symptoms until significant damage has occurred — but it is detectable with simple tests, and both infections can be managed effectively so that cirrhosis and liver cancer are prevented or caught early.