Even as several neighbouring countries in the WHO South-East Asia Region (SEARO) have made remarkable progress towards eliminating viral hepatitis, India continues to shoulder one of the world's heaviest disease burdens.
At the same time, doctors pointed out that fatty liver disease and alcohol-related damage too are taking a toll on the liver as they have become the biggest drivers of cirrhosis and liver cancer in the country.
According to the World Health Organization, the Maldives became the world's first country to receive WHO validation for the triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B, while Thailand and Sri Lanka have secured dual elimination status for HIV and syphilis and strengthened hepatitis control.
Across the South-East Asia Region, hepatitis B third-dose vaccination coverage reached 92% in 2024. However, major gaps persist. Timely birth-dose vaccination coverage remains only 58%, treatment coverage stands at a mere 0.1% for hepatitis B and 11% for hepatitis C, and only one in ten people living with chronic hepatitis B or C know their infection status. WHO also estimates that unsafe medical injections continue to account for nearly 21% of new hepatitis C infections in the region.
India has expanded antenatal screening and hepatitis B immunisation under its national programmes, but it continues to account for a disproportionate share of the global burden. WHO estimates India is among ten countries responsible for nearly 69% of hepatitis B-related deaths worldwide. Earlier estimates suggest nearly 40 million Indians are living with chronic hepatitis B infection and another 6-12 million with chronic hepatitis C, making India one of the countries with the largest number of people affected.
On the World Hepatitis Day on July 28 with the theme "Hepatitis: Let's Break It Down", experts at the All India Institute of Medical Sciences (AIIMS), Delhi, said India's biggest challenge remains the silent nature of chronic hepatitis.
"Liver disease is often called a silent disease because many patients remain completely asymptomatic until advanced liver damage has already occurred. By the time jaundice, abdominal swelling or liver failure develops, treatment becomes far more difficult," said Dr. Pramod Garg, Head of the Department of Gastroenterology at AIIMS, Delhi.
Inflammation of the liver may result from viral infections, excessive alcohol consumption, drugs or autoimmune disorders. However, viral hepatitis continues to be one of the leading causes of chronic liver disease and liver cancer in India.
Dr. Shalimar, a professor in the Department of Gastroenterology at AIIMS, Delhi, explained that different hepatitis viruses have different modes of transmission and outcomes.
While hepatitis A and E are generally spread through contaminated food and water and usually cause acute illness, hepatitis B and C are transmitted through infected blood, unsafe injections, unscreened blood transfusions, mother-to-child transmission and unsafe sexual practices.
Unlike hepatitis A and E, hepatitis B and C frequently become chronic infections that silently progress to cirrhosis, liver failure and hepatocellular carcinoma.
The doctors emphasised that viral hepatitis is now largely preventable and, in many cases, treatable.
Hepatitis C can be cured in more than 95% of patients with a three-month course of direct-acting antiviral medicines. Although hepatitis B cannot yet be cured, long-term antiviral therapy effectively suppresses viral replication and substantially lowers the risk of cirrhosis and liver cancer. However, specialists stressed that these benefits depend entirely on detecting the infection before irreversible liver injury occurs.
AIIMS experts also cautioned that India's liver disease burden is also changing rapidly because of lifestyle disorders.
Dr. Garg pointed to the growing epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, driven by obesity, diabetes, sedentary lifestyles and unhealthy diets. Recent studies estimate that nearly 38% of Indian adults and almost 35% of children now have fatty liver disease.
Dr. Shalimar further noted that alcohol contributes to nearly 43% of liver cirrhosis cases in India, followed by viral hepatitis (18%) and fatty liver disease (14%), reflecting the convergence of multiple risk factors, including unawareness.
Specialists from other hospitals echoed AIIMS' concerns about delayed diagnosis.
"Hepatitis A and E spike every monsoon because of contaminated water and poor sanitation, and most of those patients recover. But it is the hepatitis B and C cases - the quiet, chronic ones - that worry us most, because patients often don't know they are carrying the infection until liver damage is already underway. Awareness and early testing remain the biggest gaps in our country," said Dr. Saurabh Singhal, Senior Consultant and Director, Centre for Liver-GI Diseases and Transplantation, Aakash Healthcare.
"Hepatitis doesn't always announce itself. Many patients walk in for something unrelated and are stunned to learn their liver has been silently damaged for years," added Dr. Amit Miglani, Director and Head, Department of Gastroenterology, Asian Hospital. "That's why we keep pushing for opportunistic screening, especially in patients with diabetes, obesity, or a family history of liver disease, rather than waiting for symptoms to show up."
He said routine screening during health check-ups could identify thousands of infected individuals before complications develop.
"The biggest shift we need in India is treating hepatitis B and C the way we treat any chronic disease. Though hepatitis B can be kept under control with medication, we can cure hepatitis C with newer anti viral medications (DAA)," said Dr. Pavan Hanchanale, Consultant, Hepatology and Liver Transplant Physician, Jupiter Hospital, Pune.
Specialists also pointed out that hepatitis affects far more than the liver.
"Hepatitis is often perceived as a liver disease, but its impact extends far beyond the liver," Dr. Vineet Malhotra, Head of Urology, VNA Hospital said as he explained how chronic hepatitis, particularly hepatitis B and C, can disrupt hormone metabolism, reduce testosterone levels, cause fatigue and psychological stress, and contribute to sexual dysfunction, including reduced libido and erectile difficulties in some men."
He added, "Advanced liver disease may also affect sperm quality and overall fertility. Early diagnosis, timely antiviral treatment, hepatitis B vaccination and routine liver health screening can help avoid long-term complications while preserving both overall and reproductive health."
Women also require careful monitoring, particularly during pregnancy.
"Hepatitis can have important implications for women's reproductive health," said Dr. Hrishikesh Pai, Gynaecologist, Lilavati Hospital, Mumbai, and Fortis Hospital, New Delhi. "While many women with chronic hepatitis can conceive successfully, untreated hepatitis B or C increases the need for careful monitoring before and during pregnancy to reduce the risk of maternal complications and mother-to-child transmission."
"Protecting the liver begins with prevention," Dr. Garg said, advising people to avoid excessive alcohol intake, maintain a healthy weight, exercise regularly, consume a balanced diet, ensure safe drinking water, avoid unnecessary liver-toxic medicines and seek hepatitis testing if they have recognised risk factors.
