Hepatitis B and C in Pakistan: Symptoms, Testing and Treatment Guide

Pakistan carries one of the heaviest viral hepatitis burdens in the world. A national survey conducted by the Pakistan Medical Research Council found HBsAg (hepatitis B surface antigen, indicating active infection) positivity of 2.5% and anti-HCV (hepatitis C antibody) positivity of 4.9% in the general population — a combined 7.4% positivity, translating to roughly 12 million infected people nationally ("National prevalence rate of hepatitis B and C in Pakistan and its risk factors," Journal of Public Health). Pakistan is described in the infectious disease literature as being among the top four countries globally by viral hepatitis burden ("Barriers and Strategies for Hepatitis B and C Elimination in Pakistan," Journal of Infectious Diseases).

At a glance

• HBsAg (hepatitis B) positivity: 2.5% nationally; anti-HCV (hepatitis C) positivity: 4.9% (PMRC national survey)
• Combined ~7.4% of the general population, an estimated 12 million people
• Both are bloodborne viruses — not spread by casual contact, food or water
• Hepatitis C is now curable in the large majority of cases with modern oral antiviral treatment

What are hepatitis B and C?

Both are viral infections of the liver, spread through contact with infected blood — historically through unsafe injections, unscreened blood transfusions, shared razors or needles, and from mother to child during birth. They are not spread by sharing food, water, or casual household contact. Hepatitis B can be either acute (resolving on its own) or chronic (lifelong, requiring monitoring and sometimes treatment); hepatitis C very often becomes chronic if untreated, but is now curable with modern medication in most cases.

Symptoms

Both infections are frequently silent for years, especially hepatitis C — which is part of why testing matters more than waiting for symptoms. When symptoms appear, they can include:

• Fatigue
• Yellowing of the skin or eyes (jaundice)
• Dark urine
• Abdominal pain, particularly on the upper right side
• Loss of appetite and nausea
• Joint pain

Chronic infection, over years, can progress silently to liver scarring (cirrhosis) or liver cancer — which is why people with risk factors are advised to test even without symptoms.

How they spread

• Unsafe injections or reuse of needles/syringes
• Unscreened blood transfusions
• Sharing razors, toothbrushes or other items that may carry blood traces
• From mother to child during childbirth
• Unsterilised equipment used for tattoos, piercings or dental/surgical procedures
• Sexual transmission (more established for hepatitis B than C, though both carry some risk)

How they're diagnosed

A simple blood test detects both: HBsAg for hepatitis B, and anti-HCV antibody (followed by a confirmatory PCR test if positive) for hepatitis C. A gastroenterologist / liver specialist or general physician can order these, and they're worth requesting proactively if you've ever had a transfusion before widespread screening was standard, shared injection equipment, or simply want a baseline check.

Treatment

• Hepatitis C — modern direct-acting antiviral (DAA) tablets cure the large majority of cases, typically over a course of a few months, a major shift from older interferon-based treatment.
• Hepatitis B — acute infection in adults often resolves without specific treatment; chronic infection is managed with antiviral medication and regular monitoring, since it usually isn't "cured" in the same sense as hepatitis C but can be well controlled.
• Both require follow-up with a liver specialist to monitor liver function and, where relevant, screen for complications over time.

Cost and access to treatment vary by province and provider, so it's worth discussing options directly with a gastroenterologist or hepatologist rather than assuming a fixed price.

When to see a doctor

• Jaundice, dark urine or persistent fatigue and abdominal pain
• A known risk factor (past transfusion, shared needles, a household member with hepatitis) even without symptoms
• Already diagnosed and due for routine liver monitoring
• Planning pregnancy or currently pregnant with an unknown hepatitis B status

Prevention

Hepatitis B has an effective vaccine, given routinely to infants in Pakistan's immunisation schedule and available for unvaccinated adults too. There is currently no vaccine for hepatitis C, so prevention relies on safe injection practices, screened blood transfusions, and avoiding shared razors, needles or unsterilised equipment.

Frequently asked questions

Is hepatitis C really curable?

In the large majority of cases, yes — modern oral antiviral treatment achieves a cure (defined as no detectable virus after treatment) in most people who complete the course, a substantial change from older treatment options.

Can hepatitis B or C spread through food or casual contact?

No — both spread through blood contact, not through sharing meals, hugging, or using the same utensils.

Should I get tested if I feel fine?

If you have any of the risk factors above — a past transfusion, shared injection equipment, or a family member with hepatitis — testing is worth doing regardless of symptoms, since both infections are often silent for years.

Sources

• "National prevalence rate of hepatitis B and C in Pakistan and its risk factors," Journal of Public Health
• "Barriers and Strategies for Hepatitis B and C Elimination in Pakistan," Journal of Infectious Diseases

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