Hepatitis — inflammation of the liver — is a group of viral infections that can cause severe, long-term damage if left undetected. The challenge with hepatitis is that many people carry the virus for years or even decades without knowing it, because symptoms are often absent until significant liver damage has already occurred. Screening is the key to catching hepatitis early and preventing its most serious consequences.
The Different Types of Hepatitis
There are three main types of viral hepatitis that screening can detect:
Hepatitis A (HAV)
- Transmitted through contaminated food and water, or close contact with an infected person
- Usually an acute illness — the body clears the virus within weeks to months
- Does not become chronic, but can cause severe illness in rare cases
- Preventable through vaccination
Hepatitis B (HBV)
- Transmitted through blood, sexual contact, and from mother to child during birth
- Can become a chronic, lifelong infection in approximately 5% of adults infected (and 90% of infants)
- Chronic hepatitis B can silently cause cirrhosis and liver cancer over decades
- Preventable through vaccination
- Treatable but not always curable — long-term antiviral therapy can control the virus
Hepatitis C (HCV)
- Primarily transmitted through blood-to-blood contact (needle sharing, unsterile medical equipment, and less commonly through sex)
- Becomes chronic in 75-85% of cases
- Often called the "silent epidemic" because most people have no symptoms until liver damage occurs
- Now curable — direct-acting antiviral medications cure over 95% of cases in 8-12 weeks
- No vaccine is available, making screening and early treatment essential
Symptoms — Or Lack Thereof
The most dangerous aspect of hepatitis is how silent it can be. Acute hepatitis may cause:
- Fatigue and general malaise
- Nausea, vomiting, and loss of appetite
- Abdominal pain, particularly in the upper right quadrant
- Jaundice — yellowing of the skin and eyes
- Dark urine and pale-coloured stools
- Joint pain
However, many people experience no symptoms at all, especially during the chronic phase. Hepatitis B and C can damage the liver for 10, 20, or even 30 years before symptoms finally appear — by which point the damage may be irreversible.
Who Should Be Tested?
Hepatitis screening is recommended for:
- All adults at least once for hepatitis B and C as part of routine health screening
- People with multiple sexual partners or a history of unprotected sex
- Anyone who has ever injected drugs or shared needles
- People born to mothers with hepatitis B or C
- Healthcare workers and others at risk of needlestick injuries
- People who received blood transfusions or organ transplants before 1992
- People with HIV (co-infection is common)
- Travellers to regions with high hepatitis prevalence
- Anyone with unexplained elevated liver enzymes
Understanding the Markers
Hepatitis screening involves specific blood tests that look for different markers depending on the type:
Hepatitis A Markers
- Anti-HAV IgM: Indicates a current or recent hepatitis A infection
- Anti-HAV total: Indicates past infection or vaccination (immunity)
Hepatitis B Markers
- HBsAg (Hepatitis B Surface Antigen): Indicates an active infection — either acute or chronic. This is the primary screening marker
- Anti-HBc (Hepatitis B Core Antibody): Indicates past or current infection. A positive result with negative HBsAg suggests a past, cleared infection
- Anti-HBs (Hepatitis B Surface Antibody): Indicates immunity, either from vaccination or from having cleared a natural infection. A level above 10 IU/L is considered protective
Hepatitis C Markers
- HCV Antibody: Indicates exposure to hepatitis C at some point. A positive result does not necessarily mean you are currently infected — it means your body produced antibodies in response to the virus
- If HCV antibody is positive, a follow-up HCV RNA (PCR) test is needed to determine whether the virus is still active
Treatment Options
Hepatitis A
No specific treatment is needed — the body clears the virus on its own. Supportive care (rest, hydration, avoiding alcohol) is recommended.
Hepatitis B
Acute hepatitis B usually resolves without treatment. Chronic hepatitis B may require long-term antiviral therapy to suppress the virus and prevent liver damage. Regular monitoring of liver function is essential.
Hepatitis C
This is the success story of modern hepatology. Direct-acting antivirals (DAAs) cure hepatitis C in over 95% of patients within 8-12 weeks, with minimal side effects. Early detection means treatment can begin before significant liver damage occurs.
Prevention
- Vaccination: Highly effective vaccines exist for hepatitis A and B. There is no vaccine for hepatitis C
- Safe practices: Use condoms, avoid sharing needles or personal items that could carry blood
- Regular screening: For those at ongoing risk, periodic retesting is recommended
If you have any risk factors or have never been screened, getting tested is a simple step that could protect your liver — and your life.
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