Hepatitis B vs Hepatitis C: What Is the Difference, and Which Is Worse?

Hepatitis B and hepatitis C are two different viruses that both attack the liver, and the biggest difference is the ending. Hepatitis C is curable: 8–12 weeks of tablets clear the virus in more than 95% of people. Hepatitis B is usually controlled rather than cured, with long-term antiviral tablets — but it is vaccine-preventable, and hepatitis C is not.
— Dr Chetan Kalal, DM Hepatology, Gleneagles Hospital Mumbai

A composite of a conversation I have most weeks at Gleneagles Hospital: a 38-year-old software engineer comes in with a pre-employment medical report that says “HBsAg: reactive”. He has no symptoms. He has never had jaundice. His first question is whether he has “the bad hepatitis or the curable one”, and his second is whether he should stop sharing meals with his two-year-old daughter.

Both questions have clear answers, and the second one is no. But the fact that he had to ask tells you how muddled the public conversation about hepatitis has become. Hepatitis B and hepatitis C get spoken of as if they were one disease with two names. They are not. They are different viruses, spread differently, tested differently, and treated with completely different expectations. One we cure. The other we control.

This article is for the Indian patient who has just been told “you have hepatitis”, or who has a positive HBsAg or anti-HCV result from a pre-operative, pre-employment or blood-donation test and does not yet know which virus it is or what it means.

What are hepatitis B and hepatitis C, and how do they spread?

“Hepatitis” simply means inflammation of the liver. Five viruses are named for it — A, B, C, D and E — but only B and C routinely stay in the body for years and cause the slow scarring that ends in cirrhosis and liver cancer. The WHO estimated that 240 million people were living with chronic hepatitis B in 2024, and 47 million with chronic hepatitis C. Between them the two viruses killed over 1.3 million people that year.

Hepatitis B is carried in blood, semen, vaginal fluid and, in small amounts, saliva. Worldwide — and particularly in India — the commonest route is from an infected mother to her baby at birth. It also spreads through unprotected sex, shared razors or needles, and unsterile tattooing, piercing or medical procedures. Timing is everything with this virus: infection in infancy or early childhood becomes chronic in about 95% of cases, while infection acquired as an adult becomes chronic in fewer than 5%. That is why so many Indian adults with hepatitis B have carried it silently since birth and were never “careless” about anything.

Hepatitis C is a blood-borne virus almost exclusively. In India the typical stories are a reused syringe at a small clinic years ago, a transfusion before donated blood was properly screened, long-term dialysis, a roadside tattoo, or shared needles. Sexual and mother-to-child transmission do occur but, in the WHO’s words, are “less common”. Unlike hepatitis B, the virus stays in roughly 70% of the people it infects (the WHO range is 55–85%); the rest clear it on their own within months without ever knowing they had it.

Now the part my composite patient needed to hear. Hepatitis B is not spread through kissing or sharing utensils, nor through sneezing, coughing, hugging, breastfeeding, food or water. Hepatitis C is not spread through breast milk, food, water or casual contact. Nobody catches either virus by sharing a tiffin, a desk or a home. I have written more on this in liver myths and facts, because the stigma does more harm in Indian families than the virus often does.

Which tests tell me what I actually have?

Screening tests and confirming tests are different things, and confusing them causes needless fear.

For hepatitis B, the screening test is HBsAg (hepatitis B surface antigen). A positive result means the virus is present. If it stays positive beyond six months, the infection is chronic. The next tests tell us how active it is and how much damage has been done: HBV DNA (the amount of virus in the blood), HBeAg (a marker of active replication), liver enzymes, and a FibroScan to measure scarring. Anti-HBc (core antibody) tells us whether you have ever met the virus, and anti-HBs (surface antibody) tells us whether you are immune — from past infection or from the vaccine. A person who is anti-HBs positive and HBsAg negative is protected, not infected.

For hepatitis C, the screening test is the anti-HCV antibody. This is the one that generates the most panic, because a positive antibody does not mean you have the virus. It means you were exposed at some point. Around a third of exposed people clear the virus by themselves, and their antibody stays positive for life as a kind of footprint. The confirming test is HCV RNA, which detects the virus itself. Antibody positive, RNA negative: you had it once and your body cleared it; no treatment needed. Antibody positive, RNA positive: you have active infection, and it is curable.

Whichever virus it is, I also want routine liver function tests, a platelet count and an ultrasound. Normal enzymes are not proof of a healthy liver — both viruses can scar it quietly while every blood test reads within range.

Is hepatitis C curable?

Yes — the single most important sentence in this article. Hepatitis C is one of the few chronic viral infections medicine cures outright.

The treatment is a course of direct-acting antiviral (DAA) tablets, usually one tablet a day for 8–12 weeks, with longer courses reserved for particular situations such as advanced cirrhosis or previous treatment failure. The WHO puts the cure rate above 95%. In the pivotal ASTRAL-1 trial published in the New England Journal of Medicine, 624 patients across five genotypes took a single sofosbuvir-velpatasvir tablet daily for 12 weeks; 99% achieved a sustained virological response, the medical term for cure — and that included patients with cirrhosis and earlier treatment failure. The European liver society’s 2020 recommendations treat such pan-genotypic regimens as the standard of care. Side effects are few; most of my patients notice nothing at all.

India is one of the best places in the world to be treated for hepatitis C. Generic versions of these drugs are made here at a fraction of their Western price, and the National Viral Hepatitis Control Programme has offered free screening and treatment nationwide since 2018 through designated government centres. Cost should never be the reason an Indian patient leaves hepatitis C untreated.

Two cautions. Cure removes the virus, not the scarring it has already caused: a patient cured after cirrhosis has set in still needs lifelong liver cancer surveillance. And cure does not confer immunity — re-infection is possible if the original risk (unsafe injections, shared needles) continues. My full hepatitis C page covers genotypes, testing before treatment and follow-up after it.

Is hepatitis B curable?

Honestly: rarely. Hepatitis B is a controllable disease, not usually a curable one, and I would rather you heard that plainly from a hepatologist than discovered it after a course of “guaranteed cure” tablets from somewhere else.

Hepatitis B leaves a stable template of its genetic material inside liver cells, and current antivirals suppress the virus without removing that template. The medicines we use — tenofovir and entecavir, taken as one tablet a day — bring the virus in the blood down to undetectable levels in most patients, reduce inflammation, allow scarring to regress, and cut the risk of liver cancer. What they do not usually do is clear the surface antigen. A meta-analysis of 34 studies and 42,588 patients found the surface antigen cleared in about 1% of people per year, treated or untreated — roughly 4% at five years and 8% at ten. Hepatologists call that a “functional cure”, and it is the exception. For most people who qualify for treatment, the tablets are long term, often indefinite, and stopping them without specialist supervision can trigger a dangerous flare.

Not everyone with hepatitis B needs treatment. The European guidelines — updated in 2025 — base the decision on the level of HBV DNA, the liver enzymes, and the degree of liver damage; anyone with cirrhosis and detectable virus is treated, as is anyone who needs chemotherapy or immunosuppressive drugs, where the virus can reactivate. A person in the quiet “inactive carrier” phase, with low virus and normal enzymes, may need only six-monthly monitoring for years. That monitoring is not optional, because the phases change.

Once the virus is suppressed the liver recovers remarkably; my article on whether liver damage can be reversed explains what regression of fibrosis on treatment looks like. Hepatitis B treatment, like hepatitis C treatment, is available free through the national programme at government centres across India.

Hepatitis B vs C — which is worse?

The honest answer depends on what you mean by worse.

If you mean which is harder to get rid of, hepatitis B is worse. We cure hepatitis C in three months; hepatitis B we manage for years. If you mean which should I be more afraid of catching, hepatitis C is arguably worse, because there is no vaccine against it, whereas a three-dose hepatitis B vaccine offers, in the WHO’s words, nearly 100% protection. If you mean which does more damage, both cause cirrhosis and liver cancer, but hepatitis B has one extra sting: it can cause liver cancer even before cirrhosis develops, so surveillance in chronic hepatitis B is decided by individual risk, not only by scarring.

Globally, hepatitis B kills more people (1.1 million in 2024 against about 239,000 for hepatitis C), mostly because so many more people carry it and so few are diagnosed and treated. In my practice the patients who do badly with either virus share one feature: they were diagnosed late, at the point of ascites, bleeding or a liver mass, when the only option left was liver transplantation. The virus did not decide the outcome. The timing of the diagnosis did.

Either way, the discipline is the same once cirrhosis exists: six-monthly ultrasound and a blood tumour marker, which I describe in detail in my guide to liver cancer surveillance and treatment in India.

Prevention, family screening and pregnancy

Vaccinate. The hepatitis B vaccine is safe, cheap and highly effective. India’s Universal Immunisation Programme schedules a birth dose within 24 hours of delivery followed by doses at 6, 10 and 14 weeks. An adult who was never vaccinated needs three doses over six months. There is no vaccine for hepatitis C, so prevention there means insisting on single-use needles, screened blood and licensed tattoo studios.

Screen the family. Hepatitis B runs through families along the mother-to-child route, so when one person tests positive I ask for HBsAg and anti-HBs in the spouse, children, parents and siblings. Most will be uninfected (and vaccinated the same week) or already immune; those who test positive are found early, which is the whole point. Hepatitis C does not cluster in families the same way, but partners and anyone who shared the same exposure — the same dialysis unit, the same era of transfusion — should be checked.

Pregnancy. A woman with hepatitis B can have a healthy, uninfected baby. India’s programme now screens every pregnant woman for hepatitis B, and the newborn of a positive mother receives both the vaccine and hepatitis B immunoglobulin within 24 hours of birth, which prevents the great majority of transmissions. Where the mother’s viral load is very high, an antiviral tablet in the last trimester lowers it further; the European guidelines recommend this, and the specifics are for the hepatologist and obstetrician to settle together. Breastfeeding is safe. For hepatitis C, the risk to the baby is low; the usual approach is to cure the mother before or after the pregnancy.

If any of this applies to you, get tested and see a hepatologist — not in a year, now. Both viruses are far easier to deal with at the stage where you feel perfectly well.

References

1. World Health Organization. Hepatitis B fact sheet. 28 July 2026. who.int/news-room/fact-sheets/detail/hepatitis-b
2. World Health Organization. Hepatitis C fact sheet. 28 July 2026. who.int/news-room/fact-sheets/detail/hepatitis-c
3. Centers for Disease Control and Prevention. About hepatitis B. cdc.gov/hepatitis-b/about
4. Feld JJ, Jacobson IM, Hézode C, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–2607. PMID 26571066. doi:10.1056/NEJMoa1512610
5. European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73(5):1170–1218. PMID 32956768. doi:10.1016/j.jhep.2020.08.018
6. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2025;83(2):502–583. PMID 40348683. doi:10.1016/j.jhep.2025.03.018
7. Yeo YH, Ho HJ, Yang HI, et al. Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis. Gastroenterology. 2019;156(3):635–646.e9. PMID 30342034. doi:10.1053/j.gastro.2018.10.027
8. Press Information Bureau, Government of India. India’s fight to combat hepatitis (backgrounder on the National Viral Hepatitis Control Programme). 27 July 2026. static.pib.gov.in (PDF)