Chronic Hepatitis B and C Care in Northern Virginia

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Chronic hepatitis B and chronic hepatitis C are long-lasting infections of the liver caused by two different viruses. Both can go on for years, often for decades, without causing symptoms, and both can slowly lead to scarring of the liver, called cirrhosis, and to liver cancer if they are never found. The encouraging part is that both are detectable with simple blood tests, and both respond to care. Hepatitis C can now be cleared with a short course of pills in most people who are treated. Hepatitis B is usually a long-term condition that is monitored, and treated with medicine when the blood work calls for it. This guide explains who should be tested, what the results mean, what monitoring looks like, and how treatment works, with a focus on the patients we see across Northern Virginia.

This article is general education, not medical advice. A positive hepatitis test, or any concern about your liver, should be reviewed by a physician who can consider your full history.

What chronic hepatitis means

Hepatitis means inflammation of the liver. When a hepatitis virus first enters the body, the infection is called acute. Some people clear the virus on their own during that early phase. When the virus stays, the infection becomes chronic, and that is the form this guide is about. Our guide to fatty liver disease and hepatitis gives a short overview of hepatitis A, B, and C side by side. This page picks up where that one stops, with the chronic infections that need testing, follow-up, and in many cases treatment.

Whether an infection becomes chronic depends heavily on the virus and, for hepatitis B, on the age at which a person was infected. According to the Centers for Disease Control and Prevention, about 90 percent of infants infected with hepatitis B develop chronic infection, as do about 30 percent of children infected between ages 1 and 5, while about 95 percent of adults infected with hepatitis B recover completely. That is why so much chronic hepatitis B in the United States traces back to infection at birth or in early childhood, often in another country, rather than to anything a person did as an adult. Hepatitis C works differently. The CDC reports that more than half of people who become infected with hepatitis C develop chronic infection, regardless of age.

Why chronic hepatitis is often silent

The National Institute of Diabetes and Digestive and Kidney Diseases, known as NIDDK, notes that people with chronic hepatitis C likely will have few or no symptoms until complications such as cirrhosis develop, which could be decades after they were infected. Chronic hepatitis B follows a similar pattern. Many people feel entirely well while the virus is active in the liver.

That quiet course has a measurable cost. In its 2023 hepatitis B screening recommendations, the CDC estimated that 580,000 to 2.4 million people are living with hepatitis B in the United States and that about two-thirds of them do not know it. For hepatitis C, the CDC estimates that more than 2.4 million people, and possibly as many as 4 million, were living with the infection between 2017 and 2020. Chronic hepatitis appears on our list of digestive conditions that are often silent for exactly this reason. How you feel is not a reliable guide to whether you have it. A blood test is.

Who should be tested for hepatitis C

Two national bodies have issued hepatitis C screening recommendations, and they agree on the essential point: almost every adult should be tested at least once.

• The U.S. Preventive Services Task Force recommends hepatitis C screening for all adults aged 18 to 79, including people who are pregnant. The recommendation, issued in 2020, replaced an older one that covered adults born between 1945 and 1965 and others at high risk.
• The CDC recommends a hepatitis C test at least once in a lifetime for all adults 18 and older, and a test during each pregnancy.

The two recommendations overlap almost completely. The main difference is that the CDC sets no upper age limit. Both also call for testing more than once for people with ongoing risk, such as people who inject drugs. The Task Force notes that there is limited evidence on how often that repeat testing should happen, so the timing is a decision for you and your physician.

If you are an adult and cannot remember ever being tested for hepatitis C, it is reasonable to ask for the test at your next checkup. It is a blood draw, often added to blood work you are already having.

Who should be tested for chronic hepatitis B

For hepatitis B, the recommendations differ more, and it helps to know both.

In 2023, the CDC began recommending that all adults 18 and older be screened for hepatitis B at least once using a three-part blood test called a triple panel. The CDC also states that anyone who requests hepatitis B testing should receive it, regardless of whether they disclose a risk, in part because many people are reluctant to discuss risks that carry stigma.

The U.S. Preventive Services Task Force takes a risk-based approach. Its 2020 hepatitis B recommendation calls for screening adolescents and adults at increased risk, including:

• People born in countries and regions where 2 percent or more of the population has hepatitis B, such as Asia, Africa, the Pacific Islands, and parts of South America
• People born in the United States who were not vaccinated as infants and whose parents were born in regions where 8 percent or more of the population has hepatitis B
• People with HIV
• People who inject drugs
• Men who have sex with men
• Household contacts and sexual partners of people with hepatitis B

In practice, the CDC's universal recommendation means most adults are candidates for a one-time test, and the Task Force's list identifies the people for whom that test matters most.

Why chronic hepatitis B testing matters in Northern Virginia

The first group on the Task Force list is especially relevant here. According to the Task Force, people born in regions where hepatitis B is common often become infected at birth, and they account for up to 95 percent of newly reported chronic hepatitis B infections in the United States.

Northern Virginia is one of the most internationally connected parts of the country. According to the Census Bureau's American Community Survey for 2020 to 2024:

• In Fairfax County, about 354,000 of roughly 1.15 million residents were born outside the United States, and about 224,000 of them were born in Asia or Africa. That is close to one in five county residents.
• In Arlington County, about 27,000 residents, a little over one in ten, were born in Asia or Africa.
• In the City of Alexandria, about 21,000 residents were born in Asia or Africa, and more residents were born in Africa (about 12,000) than in Asia (about 9,000).

Not every country in those regions has high hepatitis B rates, and being born in one says nothing about any individual's health. What the numbers do say is that a very large share of our neighbors fall squarely within the group the Task Force identifies for screening, and that many of them may never have been offered the test. The CDC also reports that in 2023, hepatitis B-related death rates among non-Hispanic Asian and Pacific Islander people were 8.5 times as high as among non-Hispanic White people, and 2.7 times as high among non-Hispanic Black people. For families where a parent or grandparent was born in a region where hepatitis B is common, asking about testing is a practical step, and the test itself is simple.

If you have tested positive for hepatitis B or C and the result has never been evaluated, our Arlington office at (703) 522-7476 and our Annandale office at (703) 560-6106 can help you arrange a visit.

How chronic hepatitis is diagnosed

Hepatitis C testing happens in two steps. The CDC recommends starting with a hepatitis C antibody test, then following a positive antibody result with a test for the virus itself, called an HCV RNA test. The second step matters. A positive antibody test shows that a person was exposed to hepatitis C at some point, but it can also reflect a past infection that has already resolved. The RNA test shows whether the virus is present now. Only a positive RNA test means current infection.

Hepatitis B testing uses the triple panel the CDC recommends, which measures three markers in one blood draw:

• Hepatitis B surface antigen (HBsAg). A marker of current infection.
• Hepatitis B surface antibody (anti-HBs). A marker of protection, from vaccination or from recovery.
• Total hepatitis B core antibody (anti-HBc). A marker of past or current infection. Vaccination does not produce it.

Read together, the CDC notes, these results can show whether a person has a current infection, had an infection in the past that resolved but could become active again, is protected by vaccination, or has never been infected and would benefit from the vaccine. Each of those answers leads somewhere useful, whether that is further evaluation, a note in your chart for the future, or a vaccine.

Once chronic infection is confirmed, a gastroenterologist will usually want a clearer picture of the liver itself. NIDDK describes blood tests, a scan called elastography that measures liver stiffness, an ultrasound, and in some cases a liver biopsy. The goal is to learn how active the virus is and whether it has caused any scarring, because those two answers shape everything that follows.

Monitoring chronic hepatitis B over time

Chronic hepatitis B is usually a long-term relationship with your care team rather than a single course of treatment. NIDDK explains that current medicines do not eliminate hepatitis B. They suppress the virus, and they can lower the chances of liver damage and other problems.

Not everyone with chronic hepatitis B takes medicine. NIDDK notes that doctors prescribe antiviral medicines when blood tests show that hepatitis B could be causing liver damage. Many people have periods in which the virus is relatively inactive, and for them regular monitoring is the plan. The practice guidance from the American Association for the Study of Liver Diseases, known as AASLD, lists entecavir and two forms of tenofovir among the preferred antiviral medicines when treatment is needed, along with peginterferon in selected cases. Which approach fits, and when, depends on blood work that is repeated over time.

Monitoring also looks for liver cancer before it causes symptoms. The AASLD 2018 hepatitis B guidance recommends an ultrasound, with or without a blood test called alpha-fetoprotein, every six months for adults with hepatitis B who have cirrhosis. It recommends the same six-month schedule for certain adults with hepatitis B who do not have cirrhosis but are at higher risk, including Asian and Black men over 40, Asian women over 50, and anyone with a parent, sibling, or child who had liver cancer. The CDC reports that about 15 to 25 percent of people with chronic hepatitis B develop chronic liver disease, including cirrhosis, liver failure, or liver cancer. Regular monitoring is how that risk is managed rather than discovered late.

Treatment for chronic hepatitis C

Hepatitis C treatment has changed dramatically in the past decade. According to NIDDK, antiviral medicines taken as pills clear the virus in more than 95 percent of people with chronic hepatitis C, in 8 to 12 weeks. The CDC reports a similar result regardless of which genetic type of hepatitis C a person has. Earlier treatments were longer and harder to tolerate, and many people who were diagnosed years ago and told to wait may not realize how much the options have changed.

After treatment, a few steps confirm the result and keep the liver protected:

• A follow-up RNA test. Guidance from AASLD and the Infectious Diseases Society of America recommends an HCV RNA test 12 or more weeks after treatment ends to confirm that the virus is no longer detectable.
• Protection from reinfection. NIDDK notes that people who had hepatitis C in the past can get it again. The same guidance recommends yearly testing for people with ongoing risk.
• Continued monitoring for people with cirrhosis. Clearing the virus does not reverse existing cirrhosis. People with cirrhosis continue to have an ultrasound every six months to check for liver cancer, and may need an upper endoscopy to check for enlarged veins in the esophagus. For people without cirrhosis, the guidance states that follow-up is the same as if they had never been infected.

The reason to treat, even when a person feels well, is what happens without treatment. The CDC reports that about 5 to 25 percent of people with chronic hepatitis C develop cirrhosis over 10 to 20 years, and that people with hepatitis C and cirrhosis face a 1 to 4 percent risk of liver cancer each year. Our guide to cirrhosis in Northern Virginia explains that condition in more detail.

Chronic hepatitis B and medicines that suppress the immune system

This is the part of the hepatitis B story that many patients have never heard, and it is one where a gastroenterologist is often directly involved. NIDDK explains that in people who have chronic hepatitis B, or who had hepatitis B in the past, the virus may become active again later in life. That is called reactivation. NIDDK lists the medicines that raise the risk, including:

• Chemotherapy for cancer
• Medicines for conditions that involve the immune system, such as inflammatory bowel disease, rheumatoid arthritis, and psoriasis
• Medicines taken after an organ or bone marrow transplant
• Corticosteroids, if taken for more than a few weeks
• Medicines for hepatitis C

According to NIDDK, doctors may test for current or past hepatitis B in people at risk for reactivation, and can give medicines to prevent and treat it. The AASLD guidance recommends starting preventive antiviral medicine before immunosuppressive therapy for people who test positive for hepatitis B surface antigen, and it notes that people with hepatitis B who are treated for hepatitis C need monitoring during and after treatment.

For our patients with Crohn's disease or ulcerative colitis, this is why hepatitis B testing often comes up before starting certain medicines. It is also one more reason the triple panel is useful: the core antibody can reveal a past infection that a person never knew about and that still matters when immune-suppressing treatment is on the table.

Protecting your liver and the people around you

A few steps help whether you have chronic hepatitis or are simply looking after your liver:

• Vaccination. Vaccines are available to help protect against hepatitis A and hepatitis B. There is no vaccine for hepatitis C. If your hepatitis B triple panel shows you have never been infected and are not protected, your physician can talk with you about vaccination.
• Testing for close contacts. The Task Force lists household contacts and sexual partners of people with hepatitis B among the groups that should be screened. A diagnosis is often a reason to arrange testing for the family, and vaccination for those who are not protected.
• Attention to other causes of liver strain. Alcohol and fatty liver disease can add to the load on a liver already dealing with a virus. Our guide to fatty liver disease covers the metabolic side of liver health.
• Telling every prescriber. Because of the reactivation risk above, it helps for every physician who prescribes for a person with current or past hepatitis B to know about it, particularly before cancer treatment, a transplant, or a long course of steroids.

When to see a gastroenterologist about chronic hepatitis

An evaluation with a gastroenterologist is worth arranging if any of the following apply:

• A hepatitis B or hepatitis C test came back positive, whether recently or years ago
• You were diagnosed with hepatitis C in the past and were never treated, or were told at the time to wait
• You have chronic hepatitis B and are not currently having regular monitoring
• Routine blood work shows elevated liver enzymes without a clear explanation
• You are about to start chemotherapy, a biologic or other immune-suppressing medicine, or a long course of steroids, and you have current or past hepatitis B
• You have been told you have cirrhosis or liver scarring

Some symptoms call for prompt medical attention rather than a routine appointment. NIDDK lists yellowing of the eyes or skin, darker urine, and lighter-colored stools among the signs of hepatitis, and confusion or difficulty thinking among the signs of advanced liver disease. Swelling of the abdomen, vomiting blood, or black, tarry stools also need care right away. If you are not sure whether your situation calls for a specialist, our guide to when to see a gastroenterologist walks through that decision.

Chronic hepatitis care in Northern Virginia with GC of NoVA

Gastroenterology Center of Northern Virginia cares for patients across Arlington, Annandale, and the surrounding communities who are living with chronic hepatitis B or C, or who have a test result they are not sure what to do with. Our physicians can review your results, arrange the blood work and imaging that show how the liver is doing, discuss whether treatment makes sense now, and set up a monitoring schedule that fits your situation. We see patients at our Arlington office, next to VHC Health, and our Annandale office, in the Woodburn Medical complex. If this would be your first visit with a gastroenterologist, our guide to what to expect at a first appointment may be helpful. General patient information is also available from NIDDK on hepatitis B and hepatitis C.

To schedule an evaluation, contact our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106, or learn more at gcofnova.com.

This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.