LIVER UNDER SIEGE
In the silent recesses of hospitals and the invisible interiors of the human body, a silent epidemic is brewing. Hepatitis B and C, usually undiagnosed until irreparable harm is caused, have emerged as an increasing public health issue in India, including the scenic valleys of Kashmir. As compared to other infectious conditions that declare their arrival with abrupt symptoms, these viral infections insidiously enter our bodies without being noticed, gradually infecting the liver and causing fatal complications. With millions remaining unaware of their infection status, the struggle against hepatitis is not only against a virus—this is a race against time, awareness, and access to life-saving medical care.
Hepatitis B and C still survive in the dark, driven by a lack of information, unhygienic medical procedures, and poor access to early diagnosis. In India alone, where close to 40 million people unknowingly harbor the hepatitis B virus, and thousands more are unconsciously infected with hepatitis C, the problem is gigantic. India accounted for the second-highest number of cases of hepatitis B and C in 2022 after China, with 3.5 crore infections, according to a report by the World Health Organization (WHO).
Hepatitis B
It is a DNA virus with a compact genomic structure, yet it has a complex set of viral products being able to replicate in the Liver but exist In extrahepatic sites, having their own endogenous DNA Polymerase, partially double and single strand genomes, which are associated with acute and chronic hepatitis and hepatocellular carcinoma. Entry of HBV in hepatocytes is mediated by binding to the sodium taurocholate cotransporting polypeptide receptor. HBV affects the liver typically passing without being noticed for years while quietly inflicting harm. It is brought on by the Hepatitis B virus (HBV) and may result in both short-term (acute) and long-term (chronic) liver illness. Unlike most other infections, hepatitis B is not always symptomatic immediately, making it especially sinister in that individuals may transmit the disease unwittingly.
Routes of Transmission-
- Mother to child is a major route of Transmission where infected mothers can transmit the infection during childbirth.
- Unsafe medical Practices like reusing of syringes, needles, unsterilized medical equipments etc.
- Unprotected sexual contact.
- Through Blood Transfusions.
- Sharing razors or needles.
- Poor hygiene.
- Intravenous Drug Abuse.
- Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids.
Symptoms
Many people with hepatitis B remain asymptomatic for years, but when symptoms appear, they may include: Fatigue and weakness, Nausea and loss of appetite, Jaundice(Yellowing of the skin and eyes), abdominal pain, dark urine and pale stools. In chronic cases, hepatitis B can silently damage the liver, leading to complications such as liver cirrhosis (scarring), liver failure, and hepatocellular carcinoma (liver cancer). Chronic HBV infection accounts for 40-50% of hepatocellular carcinoma (HCC) and 20-30% cases of cirrhosis and chronic HCV infection accounts for 12-32% of HCC and 12-20% of cirrhosis in the country.
Diagnosis
It is not possible on clinical grounds to differentiate hepatitis B from hepatitis caused by other viral agents; hence laboratory confirmation of the diagnosis is essential. A simple blood test (HBsAg test) can detect hepatitis B infection.
Prevention
The Hepatitis B vaccine is one of the most effective ways to prevent infection. In India, it is part of the Universal Immunization Program (UIP) and is administered to infants at birth. Other preventive measures include- avoid needle sharing, ensuring sterile medical procedures, practicing safe sex, screening of pregnant women, general hygiene etc.
Treatment
While there is no complete cure for chronic hepatitis B, effective treatments can help control the virus and prevent liver damage. Most cases of acute hepatitis B resolve on their own as the immune system fights off the infection, some supportive treatment Include – Rest and hydration, good diet, and avoiding of alcohol and liver toxic drugs. Chronic hepatitis B infection can be treated with oral medicines, including tenofovir or entecavir to slow the advance of disease.
Although Hepatitis B is still a major public health issue, it is not the sole viral infection that quietly assaults the liver. Hepatitis C, which is overshadowed by Hepatitis B, is just as deadly—but with one major distinction: it can be cured. In contrast to Hepatitis B, which can be controlled but not eradicated, current antiviral medications can fully eradicate Hepatitis C from the body.
Notwithstanding, millions of individuals do not even know they have it, because Hepatitis C produces no symptoms during its early periods. Unchecked, it causes liver cirrhosis, liver failure, and even cancer. In India, including Jammu and Kashmir, unsafe injection practices, drug injections, and low awareness perpetuate the transmission of this illness. Unlike Hepatitis B, which has a vaccine, Hepatitis C has no vaccine but is curable with antiviral medications. ‘
Hepatitis C
The hepatitis C virus is a blood borne virus. It is most commonly transmitted through: the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings; the transfusion of unscreened blood and blood products; and injecting drug use through the sharing of injection equipment. Though it can also spread through mother to baby or by sexual contact but these are less common. Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Symptoms
People do not have symptoms in the first weeks after infection. It can take between two weeks and six months to have symptoms.
When symptoms do appear, they may include: fever, feeling very tired, loss of appetite, nausea and vomiting, abdominal pain, dark urine, pale faeces, joint pain, jaundice (yellowing of the skin or eyes).
Diagnosis
Since Hepatitis C is often silent, early diagnosis is crucial to prevent liver damage and start treatment. The diagnosis involves-
- Hepatitis C Antibody Test (Anti HCV).
- PCR Test.
- HCV genotyping.
- Fibroscan, Liver biopsy- determine extent of damage.
Ways to prevent hepatitis C include
Safe and appropriate use of healthcare injections, safe handling and disposal of needles and medical waste, harm-reduction services for people who inject drugs, such as needle exchange programs, substance use counselling and use of opiate agonist therapy (OAT), testing of donated blood for the hepatitis C virus and other viruses,practicing safe sex.
With the development of medical science and government programs such as India’s National Viral Hepatitis Control Program (NVHCP), we possess the means to combat these infections effectively. The fight against Hepatitis B and C, though, is not merely a health issue—it calls for concerted action from people, healthcare professionals, and policymakers alike to ensure a future where these diseases are no longer a public health concern.
The message is clear: Get tested, get treated, and protect your liver health—because early action saves lives.
(The Author is Intern Doctor and Health Columnist. Email- [email protected])
