Hepatitis B & C

The Problem

Hepatitis B antivirals: effective (suppress virus, prevent progression) but lifelong treatment (not curative—virus integrates into DNA, remains dormant), expensive ($300-500/month—often covered by insurance), resistance can develop (rare with tenofovir, entecavir), doesn't cure (functional cure possible—HBsAg loss—but rare 1-3%/year), Interferon (older treatment): significant side effects (flu-like symptoms, depression, bone marrow suppression, thyroid dysfunction), limited efficacy (30-40% response), rarely used now, Hepatitis C DAAs: highly effective (95%+ cure—life-changing) but very expensive ($50,000-100,000 for treatment course—often covered by insurance or patient assistance programs, price dropping with generics), drug interactions (many), rare resistance, reinfection possible (if continued IV drug use—harm reduction critical), Liver transplant (if cirrhosis, liver failure): major surgery, lifelong immunosuppression, organ shortage, expensive, Hepatitis C can reinfect transplanted liver (treated with DAAs post-transplant), Conventional doesn't emphasize: liver support during treatment (milk thistle, NAC, SAMe, antioxidants support liver during viral clearance), lifestyle factors (alcohol cessation critical, weight loss if fatty liver, exercise), gut health (gut-liver axis—probiotics, gut healing support liver), co-infections (treat HIV, eradicate H. pylori if present—worsens outcomes), metabolic factors (diabetes, insulin resistance worsen liver disease—optimize), prevention of reinfection (Hep C patients who continue IV drug use—harm reduction, needle exchange, addiction treatment), Many Hepatitis C patients not treated: 50% of HCV+ patients in US unaware of infection (asymptomatic for decades until cirrhosis develops—screening inadequate), many diagnosed but not treated (access issues, cost, insurance denials, patient fear of treatment—despite 95% cure rate with modern DAAs), Hepatitis B vaccine underutilized: all adults should be vaccinated (safe, effective, prevents chronic infection), sexual partners and household contacts of HBV+ patients should be vaccinated, newborns of HBV+ mothers (given vaccine + immunoglobulin at birth—prevents 90% of mother-to-child transmission), Harm reduction for IV drug users: clean needle programs, supervised injection sites, addiction treatment—prevent transmission, support recovery, Many patients with chronic hepatitis develop cirrhosis and cancer that could be prevented: HCV—cure with DAAs prevents progression, HBV—suppressive antivirals prevent progression, Alcohol cessation critical (accelerates damage, increases cancer risk 5-10x), Weight loss if fatty liver (NAFLD worsens hepatitis).