Liver damage without symptoms: The silent spread of hepatitis in India

In India, millions of people are living with hepatitis B or C and don’t even know it. You could feel completely fine, go to work every day, eat normally, sleep normally, and still have a virus quietly damaging your liver.

By the time symptoms show up, the damage is often already serious. We’re talking about cirrhosis. Liver failure. Even liver cancer."A high burden of hepatitis viruses is present in India. Approximately 3-4% of the population is infected with Hepatitis B virus (HBV) while 0.5-1% of people have Hepatitis C virus (HCV). As a result, there are probably more than 10 million people in India who are living with chronic HBV or HCV infections.

Many people do not know that they are infected with either virus because both viruses can remain dormant for many years, and individuals can feel well until significant liver damage has occurred," Dr.

Souradeep Chowdhury, Department - Internal Medicine, Medanta Hospital Noida told TOI Health.

Hepatitis burden in India

Hepatitis remains a major public health challenge in India, with viral types A, B, C, D, and E driving most cases and contributing to high rates of cirrhosis and liver cancer. India bears a heavy burden of hepatitis.

Hepatitis B surface antigen prevalence in India is approximately 0.95%. HCV prevalence is approximately 1% overall. A Lucknow meta-analysis (via NVHCP) pooled data found wide regional spread which was linked to unsafe injections and transfusions. Half of cases are in adults aged 30-54, with 12% in children.Hepatitis A (HAV) causes 10-30% of acute hepatitis cases, often in poor sanitation areas. HEV or hepatitis E virus drives 10-40% of acute hepatitis and 15-45% of acute liver failure, especially in pregnancy. Yet awareness is shockingly low. Many still believe liver disease only happens to people who drink heavily. Others assume hepatitis spreads through casual contact, which simply isn’t true. And because testing isn’t routine for most adults, the virus continues to slip under the radar.Dr. Souradeep Chowdhury addressed some key questions about hepatitis, helping clear common misconceptions around the disease.

What are the long-term health consequences of untreated hepatitis B or C?

The untreated infections cause progressive liver fibrosis (cirrhosis) which may lead to liver cancer (hepatocellular carcinoma). Hepatitis C can be cured; however early diagnosis is necessary. If the diagnosis of hepatitis C is delayed the liver will be damaged and cannot be repaired. Most cases of hepatitis B require long term therapy as there is a risk of the disease being fatal if it goes untreated.

How do people usually contract hepatitis B or C, and what are the common myths around transmission?

The main ways somebody gets hepatitis are if they get a dirty needle, get a blood transfusion from an unscreened donor; have surgery or dental work done with a dirty object; if they get a tattoo or piercing with a dirty object or pass from a mother to her child at delivery.

A common myth is that hepatitis can be spread by sharing a meal, hugging, coughing, or other casual contact - this is not true and leads to unnecessary shame.

Why is awareness about hepatitis so low?

Hepatitis does not exhibit the same level of visibility as diseases, such as TB or HIV. There has historically been less routine screening for hepatitis, limited public health messaging surrounding the disease, and centuries of social stigma attached to testing for hepatitis; as a result, people do not get tested or treated.

Many people believe that only people who consume alcohol will develop liver disease, which is simply not the case.

How easy is it for an average Indian to get tested and treated for hepatitis?

Getting tested for hepatitis today is quite simple and inexpensive, requiring only a blood test for most types of hepatitis. Treatment has also become much more accessible, with hepatitis C now curable using oral medications taken for 8 to 12 weeks. However, awareness about hepatitis, pathways to referral, and the availability of follow-up care are not yet appropriately distributed throughout the world.

Can lifestyle choices, like alcohol consumption or diet, worsen hepatitis-related liver damage?

Yes, definitely. People with hepatitis B or C have accelerated liver damage when consuming alcohol. Other factors that contribute to increased liver damage in people with hepatitis include an unhealthy diet, obesity, and poorly controlled diabetes. People who drink moderately can also be harmed if they have chronic hepatitis.

What challenges do doctors face in diagnosing and treating these silent infections?

One of the primary causes of the challenge of late presentation in patients is a late presentation of complications and also with many problems, missed opportunities for appropriate screening, poor access to specialist care, incomplete follow-up care, and persistent misconceptions among both patients and some healthcare professionals.

If you could give one urgent message to the public about hepatitis B and C, what would it be?

If you have received any type of injection, surgery, transfusion or any kind of medical procedure, then it is important that you get tested. While you can prevent hepatitis B by getting vaccinated and you can cure hepatitis C, diagnosing hepatitis early on can help save your life and your liver.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr. Souradeep Chowdhury, Department - Internal Medicine, Medanta Hospital NoidaInputs were used to explain how hepatitis remains a silent health crisis in India and how people can prevent the onset of the disease by identifying the symptoms and taking preventive steps.