Receiving a hepatitis B or C diagnosis often comes with fear and confusion, but expert guidance can transform anxiety into action. Unnikrishnan S catches up with Dr Charles Panackel, senior consultant – hepatology, Aster Medcity, Kochi, to address the most critical questions patients and their families face—covering diagnostic tests, family vaccination, routine scans, and holistic wellness. Edited excerpts:
What is the very first step or test you walk a patient through once they receive a positive hepatitis diagnosis?
First we need to determine whether it is acute or chronic hepatitis B. Tests such as HBsAg, IgM HBcAg, HBV DNA, and HBeAg are run, and based on the results we determine whether it is chronic or acute hepatitis B. For hepatitis C, if the anti-HCV test is positive, we confirm it with an HCV RNA blood test. If that turns out positive, we can confirm the patient has chronic hepatitis C. After that (for both hepatitis B & C), we need to assess how much the liver has been damaged — for that, we do a liver function test, prothrombin time, liver ultrasound and fibroscan (for hepatitis B). For hepatitis B, treatment is decided based on whether it is acute or chronic and extend of liver damage. All patients with chronic hepatitis C and high viral load need treatment.
How often should someone with chronic hepatitis B or successfully cured hepatitis C visit their liver specialist or get monitoring scans?
People with chronic hepatitis B should get a blood test every six months — complete blood count, LFT, alpha-fetoprotein — and a liver ultrasound, since liver damage can lead to liver cancer. For chronic hepatitis C that has been cured, follow-up depends on the extent of liver damage. If there is cirrhosis, blood checks and ultrasound scan are needed every six months. If there is no liver damage, one more hepatitis C RNA check is done after six months of completing treatment, and if it’s negative, no further follow-up is needed.
How does treating hepatitis impact a person’s overall health beyond just their liver function?
Hepatitis B and C can affect organs other than liver. Hepatitis B has multiple extrahepatic manifestations — it can cause immune-mediated arthritis, vasculitis, and kidney problems. Chronic HCV can also cause diabetes, immune complex disorders and lymphoma. So, treating them also helps prevent these diseases from developing.
Beyond medication, what role does mental health or emotional support play in a patient’s recovery or long-term management?
It’s always frightening for people when they think of hepatitis B or C — there is also a social stigma attached to it. Emotional support is needed. Counselling is needed before screening, and if the result is positive, patients need detailed guidance on how it will be treated and that it is curable. Throughout the treatment period, both the patient and family members need support.