Hepatitis B and C: who should be tested, and why it is worth it now

Most people who come to us with hepatitis C were not looking for it. It turns up in a pre-operative screen, in a blood donation, in a routine test before a marriage, or in a liver enzyme done for something unrelated. They feel perfectly well, and the first thing they ask is how long they have had it. The honest answer is often twenty years.

That gap is the whole issue. Hepatitis B and C damage the liver quietly for decades before producing a single symptom, and by the time jaundice, a swollen abdomen or vomiting of blood appear, a large amount of that damage is permanent. Between those two points sits a blood test that costs very little.

Who should be tested

In this district, we would test anyone who fits any of the following:

• Anyone who has ever received a blood transfusion, particularly before the late 1990s
• Anyone who has had surgery, a dental procedure, an endoscopy or a dialysis session anywhere the sterilisation was not certain
• Anyone who has had injections from an unqualified practitioner, or repeated drips and injections from a local clinic
• Anyone shaved with a barber's reused razor, or who has had ear or nose piercing, cupping, or a tattoo with shared equipment
• Every pregnant woman, at every pregnancy — hepatitis B passed to a newborn is preventable at birth and devastating if missed
• Every household member and sexual partner of someone already diagnosed
• Anyone with persistently raised liver enzymes, however mildly
• Anyone over thirty-five who has simply never been tested. This is the single largest group we find infections in.

“There is no group in this country for whom 'I feel fine' is a reason not to be tested once.”

How it is really transmitted — and how it is not

Both viruses travel through blood. In Pakistan the dominant routes are medical and cosmetic: reused syringes, unsterilised instruments, unscreened transfusions, shared razors. Hepatitis B is additionally passed sexually and from mother to child at birth, which hepatitis C does far less often.

What does not spread either virus is worth saying as plainly, because the stigma does real damage to families: sharing food, plates or cups; hugging, kissing or shaking hands; coughing and sneezing; sharing a bathroom, a bed or a prayer mat; mosquito bites. A person with hepatitis B or C does not need separate utensils, and should not be made to eat alone.

Your result, and what happens next

Anti-HCV positive

This means you have been exposed to hepatitis C at some point. It does not by itself mean the virus is still in your body — a minority of people clear it naturally and keep the antibody for life. The next step is an HCV RNA (PCR) test, which asks whether the virus is actually present now. Treatment decisions are made on that test, never on the antibody alone.

HBsAg positive

This means hepatitis B is present. It needs further tests — viral load, liver enzymes, HBeAg and an ultrasound — to determine whether it is in a phase that requires treatment or one that requires monitoring. Many people with hepatitis B never need tablets, but everyone with it needs to stay under review rather than be discharged and forgotten.

Both negative

Good. If you are not already vaccinated against hepatitis B, this is the moment to complete the three-dose course — it is cheap, it is safe, and there is no vaccine at all for hepatitis C, which makes protecting against B the only vaccine-shaped opportunity you get here.

Hepatitis C is genuinely curable now

This is the part that has not reached everyone. The old treatment was months of interferon injections with hard side effects and modest success. It has been replaced by direct-acting antivirals: usually one tablet a day for twelve weeks, generally well tolerated, and curing well over ninety per cent of people. The medicines are manufactured locally and are far cheaper here than in most of the world.

Cure is confirmed by a PCR test twelve weeks after the course finishes. A cure does not make you immune, so the exposures that caused it in the first place still need to be avoided afterwards.

If you are already diagnosed

• Stop alcohol entirely, and be careful with paracetamol-containing combination medicines
• Do not take herbal or hakeem liver tonics without telling us what is in them — several are directly hepatotoxic
• Get your household tested, and vaccinated against hepatitis B where they are negative
• Keep the ultrasound and blood monitoring appointments even when you feel completely well; screening for liver cancer in cirrhosis works only if it is done on schedule
• Tell every dentist, surgeon and lab technician who treats you — not for their sake, which is covered by standard precautions, but so your own care is planned properly

If you have never been tested, treat this article as the reminder. One blood sample, taken at a routine visit, answers a question that otherwise waits twenty years to answer itself.