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Chronic Hepatitis B & C

Clinical Subject Page

Chronic Hepatitis B & C

Chronic hepatitis B (HBV) and chronic hepatitis C (HCV) are persistent viral infections of the liver
that can lead to progressive liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma
(HCC)

ICD-10

B18.1 + B18.2

Specialty

Gastroenterology

Onset

Chronic

Reviewed

July 2026

On This Page

Overview

• Chronic HBV is defined by persistence of HBsAg for ≥6 months.
• Chronic HCV is persistent HCV infection confirmed by detectable HCV RNA.
• Many patients are asymptomatic for years.
• Major long-term complications include cirrhosis and hepatocellular carcinoma.

Etiology & Risk Factors

Hepatitis B
• Chronic HBV infection
• Perinatal transmission
• Sexual transmission
• Blood exposure
• Intravenous drug use


Hepatitis C
• Intravenous drug use
• Blood exposure
• Transfusion before screening programs
• Occupational exposure

Pathophysiology

• Persistent viral infection causes chronic hepatic inflammation.
• Progressive hepatocyte injury results in fibrosis.
• Fibrosis may progress to cirrhosis.
• Long-standing disease increases the risk of hepatocellular carcinoma

Clinical Presentation

-Many patients are asymptomatic.
Possible symptoms include:
• Fatigue
• Malaise
• Nausea
• Poor appetite
• Mild abdominal discomfort
• Hepatomegaly
• Features of cirrhosis in advanced disease
• Decompensated liver disease in severe cases

History Taking

-Ask about:
• Previous hepatitis infection
• Vaccination history
• Blood transfusions
• IV drug use
• Sexual history
• Occupational exposure
• Family history of liver disease or HCC
• Alcohol intake
• Metabolic syndrome
• Symptoms of cirrhosis
• Previous antiviral treatment

Physical Examination

• General examination
• Jaundice (if advanced)
• Hepatomegaly
• Splenomegaly
• Signs of chronic liver disease
• Signs of portal hypertension
• Ascites
• Peripheral edema
• Hepatic encephalopathy

Investigations

1. Liver chemistry
• ALT • AST • Bilirubin • ALP • GGT


2. Assessment of liver function
• Albumin • INR/PT • Platelet count


3. HBV-specific investigations
HBsAg, Anti-HBc, Anti-HBs, HBeAg, Anti-HBe, HBV DNA.
Chronic HBV is confirmed if HBsAg remains positive for ≥6 months.


4. HCV investigations
• Anti-HCV antibody
• HCV RNA


5. Assess liver fibrosis
• Liver elastography (FibroScan) • APRI • FIB-4


6. Screen for coinfections
• HCV (for HBV patients) • HDV • HIV • Hepatitis A immunity


7. Imaging
• Abdominal ultrasound for liver assessment and HCC surveillance


8. Liver biopsy
Consider for diagnostic uncertainty or treatment decisions.

Diagnosis

-Diagnosis is based on :

  • clinical evaluation,
  • liver function tests,
  • HBV serology or HCV antibody/RNA
    testing, HBV DNA or HCV RNA,
  • fibrosis assessment, and imaging when indicated.
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Management

General measures
• Avoid alcohol.
• Avoid hepatotoxic medications.
• Vaccinate against hepatitis A if nonimmune.
• Monitor liver function regularly.
• Manage metabolic risk factors.
• Screen for HCC when indicated.


Chronic HBV
Goals: Suppress viral replication, prevent cirrhosis and HCC.
Treatment: Tenofovir or Entecavir in eligible patients based on HBV DNA, ALT and fibrosis.


Chronic HCV
Goal: Cure infection.
Treatment: Direct-acting antivirals (DAAs).


Follow-up
Monitor viral load, liver enzymes, fibrosis progression and continue HCC surveillance in at-risk
patients.

Complications

• Liver fibrosis
• Cirrhosis
• Portal hypertension
• Hepatic decompensation
• Hepatocellular carcinoma
• Liver failure

Prognosis

• Excellent if diagnosed early and treated appropriately.
• Chronic HBV can often be effectively suppressed with antiviral therapy.
• Chronic HCV is usually curable with DAAs.
• Prognosis worsens once cirrhosis or hepatocellular carcinoma develops.

Key Points / Clinical Pearls

• Chronic HBV = HBsAg positive for ≥6 months.
• Evaluate every patient for liver fibrosis.
• HBV investigations: HBsAg, anti-HBc, anti-HBs, HBeAg, anti-HBe, HBV DNA.
• HCV diagnosis: anti-HCV then HCV RNA.
• FibroScan, APRI and FIB-4 stage fibrosis.
• Ultrasound is important for fibrosis assessment and HCC surveillance.
• Treat eligible HBV with tenofovir or entecavir.
• Treat HCV with DAAs.
• Regular monitoring helps prevent cirrhosis and liver cancer