Liver Scarring May Result from a Persistent HBV Infection

Morah Terrault^*
*Correspondence: Morah Terrault, Department of Hepatology, University of California San Francisco, San Francisco, CA, USA, Email:

Introduction

Hepatitis B and C are viral infections that pose significant threats to liver health, affecting millions worldwide. Left untreated, these infections can progress to chronic liver disease, cirrhosis, and even liver cancer. Despite their silent nature, often presenting with few or no symptoms, understanding their transmission, clinical manifestations, and treatment options is essential for mitigating their impact on public health. This article explores the complexities of Hepatitis B (HBV) and Hepatitis C (HCV), highlighting their modes of transmission, risk factors, diagnostic procedures, treatment options, and the importance of awareness in curbing their spread [1].

Description

Both HBV and HCV primarily target the liver, causing inflammation that can lead to severe long-term liver damage. While these infections share similarities in how they spread, they differ in their modes of transmission and prevention strategies. HBV is transmitted through contact with infected blood, semen, or other body fluids. This includes unprotected sexual contact, sharing needles, and receiving contaminated blood products. Vertical transmission, where an infected mother passes the virus to her child during childbirth, is also a significant concern. Unlike many other viral infections, HBV can survive outside the body for extended periods, making it easier to spread through contaminated surfaces or shared items like razors. Vaccination against HBV is one of the most effective methods of preventing its spread. The HBV vaccine is included in routine immunization programs, and it is especially important for infants, healthcare workers, and individuals at higher risk, such as people who inject drugs or those with multiple sexual partners. HCV, like HBV, is primarily spread through blood-to-blood contact. This commonly occurs among individuals who share needles or other drug paraphernalia. Before the implementation of rigorous blood screening measures, HCV was also transmitted through unscreened blood transfusions and organ transplants. Unsafe medical practices, such as the use of non-sterile equipment, are additional risk factors. While sexual transmission of HCV is less common than HBV, it can still occur, particularly in individuals with multiple sexual partners or those who engage in high-risk behaviors. Unlike HBV, there is no vaccine for HCV, making prevention efforts focused on reducing exposure to the virus through safe practices and harm reduction strategies. People who inject drugs are especially at risk, as needle-sharing remains one of the most common modes of transmission [2].

Both HBV and HCV infections can be classified as either acute or chronic. Acute infections often do not exhibit symptoms, making them difficult to detect without medical testing. When symptoms do appear, they may include fatigue, nausea, jaundice, and abdominal pain. However, these symptoms are often mild or mistaken for other illnesses, which is why many individuals with acute Hepatitis B or C may remain unaware of their condition. In some cases, acute infections can resolve on their own without causing long-term damage. However, in many individuals, especially those who are infected at birth or during early adulthood, the infection becomes chronic. Chronic infection occurs when the virus remains in the body for an extended period, leading to persistent inflammation. Over time, this inflammation can cause scarring of the liver, known as cirrhosis. Cirrhosis impairs liver function and increases the risk of liver failure and liver cancer.

The risk of developing cirrhosis and liver cancer is higher in people with chronic HBV or HCV, particularly if the infection is not diagnosed and treated early. Both HBV and HCV can also affect other organs, leading to extrahepatic manifestations such as glomerulonephritis, which impacts kidney function, and cryoglobulinemia, a condition that can cause blood vessel inflammation. These complications highlight the importance of early diagnosis and effective management of both infections [3].

Early detection of HBV and HCV is crucial for preventing liver damage and minimizing the risk of complications. Diagnosis typically involves a combination of blood tests and liver imaging. For HBV, blood tests are used to detect the presence of specific viral markers, such as Hepatitis B surface antigen (HBsAg), antibodies against the virus (Anti-HBs, Anti-HBc), and the level of viral DNA (HBV DNA). These tests help determine if the infection is acute or chronic and if there is ongoing viral replication, which increases the risk of liver damage. Liver imaging techniques, such as ultrasound, and more advanced methods like elastography, assess the degree of liver fibrosis (scarring). This information helps doctors evaluate the need for antiviral therapy or other interventions. The diagnosis of HCV begins with an antibody test (anti-HCV) to determine whether an individual has been exposed to the virus. If the antibody test is positive, a follow-up test measuring the level of HCV RNA (genetic material) confirms whether the infection is active. The HCV RNA test also helps assess the viral load and can be used to monitor treatment effectiveness. Liver imaging, such as elastography, is used to evaluate the extent of liver damage and fibrosis. These tests are essential for determining whether liver cirrhosis or other complications have developed [4].

Prevention is the cornerstone of controlling the spread of Hepatitis B and C. The most effective preventive measure for Hepatitis B is vaccination. The HBV vaccine is safe, effective, and widely available, and it is part of routine immunization programs worldwide. Hepatitis C, however, has no vaccine, making prevention efforts focus on reducing exposure to the virus. This includes ensuring safe blood products, promoting safe injection practices, and encouraging condom use to reduce the risk of sexual transmission. Public health campaigns aimed at educating individuals about the risks and prevention strategies for both HBV and HCV are crucial. These campaigns should target high-risk populations, such as people who inject drugs, healthcare workers, and individuals with multiple sexual partners, while also increasing awareness among the general public about the importance of screening and early detection [5].

Conclusion

Hepatitis B and C are significant global health challenges, but with increased awareness, early detection, and modern treatment options, their impact on liver health can be minimized. By understanding how these viruses are transmitted, recognizing their clinical presentations, and advocating for prevention and treatment, we can reduce the burden of chronic liver disease, cirrhosis, and liver cancer. Continued education, public health initiatives, and access to effective healthcare are vital for controlling the spread of these infections, improving patient outcomes, and ultimately preventing the devastating effects of Hepatitis B and C on millions of lives around the world.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Saito, I., T. Miyamura, A. Ohbayashi and H. Harada, et al. "Hepatitis C virus infection is associated with the development of hepatocellular carcinoma."Proc Natl Acad Sci 87 (1990): 6547-6549.

Google Scholar, Cross Ref, Indexed at

2. Mason, William S., Carol Aldrich, Jesse Summers and John M. Taylor. "Asymmetric replication of duck hepatitis B virus DNA in liver cells: Free minus-strand DNA."Proc Natl Acad Sci 79 (1982): 3997-4001.

Google Scholar, Cross Ref, Indexed at

3. Yang, Bei and Michael J. Bouchard. "The hepatitis B virus X protein elevates cytosolic calcium signals by modulating mitochondrial calcium uptake."Virol J 86 (2012): 313-327.

Google Scholar, Cross Ref, Indexed at

4. Ron, David and Peter Walter. "Signal integration in the endoplasmic reticulum unfolded protein response."Nat Rev Mol Cell Biol 8 (2007): 519-529.

Google Scholar, Cross Ref, Indexed at

5. Haynes, Cole M., Eric A. Titus and Antony A. Cooper. "Degradation of misfolded proteins prevents ER-derived oxidative stress and cell death."Mol Cell 15 (2004): 767-776.

Google Scholar, Cross Ref, Indexed at