Hepatitis is inflammation of the liver—an organ we depend on to digest nutrients, filter blood, and overcome infection. There are many different types of hepatitis, including hepatitis A, B, C, D, and E, with symptoms that include fever, abdominal pain, nausea, jaundice (yellowing of the skin and eyes), and fatigue.
However, most people with chronic viral hepatitis do not experience any symptoms and often do not know they have the infection even while it silently damages their liver. Hepatitis B and C are among the most common types of hepatitis. While they both affect the liver, they are very different.
Douglas Dieterich, MD
In this Q&A, Douglas Dieterich, MD, Professor of Medicine (Liver Diseases) and Director of the Institute for Liver Medicine at the Icahn School of Medicine at Mount Sinai, explains the differences between hepatitis C and B, how they are transmitted and treated, who is at risk, and more.
What is the difference between hepatitis C and B?
Hepatitis C virus (HCV) and hepatitis B virus (HBV) are vastly different viruses. Hepatitis B is highly contagious through sex, using drugs with shared straws and needles, blood transfusions, and even saliva, which can put people living in the same household at risk. The good news is hepatitis B is entirely preventable with a vaccine, which has been around since 1991. The Centers for Disease Control and Prevention now recommends universal vaccination for hepatitis B for all adults under 60 who did not get vaccinated by their pediatrician starting in 1991. People over 60 can also request the vaccine and should, especially if they have ongoing risk factors. If people do get hepatitis B, there are very good drugs to control it and to suppress the virus down to zero so it doesn’t do any damage or infect others. We also have exciting clinical trials happening to study medications that can cure Hepatitis B.
Currently, there is no vaccine for hepatitis C, which is a different class of virus. It actually belongs to a class that you may have heard of—West Nile virus, dengue fever, yellow fever, and Zika, which has been in the news the last few years. None of those become chronic, however, while hepatitis C does. Over time, it can cause the same liver damage that hepatitis B can, including liver cancer, which can lead to death. The good news is, it’s now easily curable. We have fantastic new drugs for hepatitis C—most patients need to take only 8 to 12 weeks of easy-to-take pills with virtually no side effects and a 99 percent cure rate. It’s absolutely important to find out if you have hepatitis C or B because we can cure hepatitis C and control hepatitis B.
What do I need to know about hepatitis D?
Hepatitis D, also known as hepatitis Delta virus (HDV), is the most severe form of viral hepatitis. This is a type of hepatitis that can only infect people who have hepatitis B. Approximately 70 percent of people who have hepatitis Delta will develop cirrhosis (liver scarring) within 5 to 10 years of infection. This is a much higher and faster progression than for most people with hepatitis C and hepatitis B.
Hepatitis Delta can only function in a body that is also infected with hepatitis B. Not everyone with hepatitis B has hepatitis Delta, but everyone with hepatitis Delta also has hepatitis B. That’s why we recommend everyone with hepatitis B get screened for hepatitis Delta too.
New effective treatments for hepatitis Delta are coming soon and are already available to some patients, depending on their specific health situation. Our providers can screen you for hepatitis Delta and help get you onto treatment if needed.
Who is at risk for contracting hepatitis B and C, and who should get screened?
The CDC recommends all adults be screened for hepatitis B and C at least once in their life, even if they don’t think they have any risk factors. Many people have been exposed but don’t know it. The major method of transmission for hepatitis B, globally, is from mother to infant at birth. Other people who are at risk are those who have never been vaccinated—primarily people born before 1991—and we see that happening now. When people born before 1991 come in contact with people who have hepatitis B, they can catch it quite easily. Hepatitis C is more difficult to catch. The major risks for hepatitis C are having had a transfusion of blood or blood products, such as gamma globulin, before 1992, or using IV drugs or intranasal drugs. Just snorting drugs with a straw is enough to spread Hepatitis C. People who have unprotected sex—especially men who have sex with men—are also at risk for hepatitis C. It’s very important to get diagnosed early so you can get treated and cured. If you know you have ongoing risk factors, you should be screened at least once a year.
Why is hepatitis more common in New York City?
About 48 percent of the people who live in New York City were born outside of the United States. Many of those people come from countries where hepatitis B or C is endemic, and that’s the major risk factor for hepatitis B. Endemic means that a high percentage of people in an area have the disease and therefore the risk of getting the disease is high. The New York City Department of Health and Mental Hygiene estimates that 243,000 New Yorkers, or 2.9 percent of the population, have chronic hepatitis B. The Department also estimates that approximately 86,000 New Yorkers, or 1 percent of the population, have chronic hepatitis C. If we catch viral hepatitis early, we can help you prevent liver scarring and liver cancer.
What is the best way to prevent hepatitis B and C?
The best way to prevent hepatitis B is to get vaccinated for hepatitis B. The CDC now recommends everyone aged 18 to 59 be vaccinated for hepatitis B. If you weren’t vaccinated as a kid, it’s easy to check if you have antibodies to hepatitis B, or if you have hepatitis B, we can treat that. Ask your doctor about testing and vaccination.
Hepatitis C is mostly spread blood to blood. Shared needles—if you’re using IV drugs, and shared straws if you’re using intranasal drugs—things like that—are really high risk for spreading hepatitis C. Getting a tattoo or piercing from an unlicensed technician may also put you at risk if they are not properly cleaning their needles. If you are using drugs, don’t share needles, don’t share straws. And get tested for hepatitis C, because if you have it, we can cure it. Once cured, you can become reinfected with hepatitis C, so it’s very important to continue avoiding infection after getting cured, which means not sharing needles or straws and practicing safe sex, and only getting tattoos and piercings from licensed technicians.
What resources are available at Mount Sinai for screening and treatment of hepatitis?
We have numerous resources dedicated to screening and treatment of hepatitis B and hepatitis C at Mount Sinai. We’re the largest independent liver program in the country. We have liver clinics all over Manhattan and the metropolitan area—from Long Island to Westchester. Our care coordinators will support you from screening through treatment and cure, working closely with your provider to ensure you get the best care.