Hepatitis B & C Treatment in Dallas, TX

What Is Viral Hepatitis?

Viral hepatitis is an infection of the liver caused by one of several hepatitis viruses. The most clinically significant forms in the United States are hepatitis B (HBV) and hepatitis C (HCV), both of which can cause chronic infection that silently damages the liver over years or decades. Left untreated, chronic hepatitis B and C can lead to progressive liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma (liver cancer).

According to the Centers for Disease Control and Prevention (CDC), an estimated 580,000 to 2.4 million people in the United States are living with chronic hepatitis B, and approximately 2.4 million are living with chronic hepatitis C. Many of these individuals are unaware of their infection, which is why universal screening is now recommended for all American adults.

At Texas Gut Health in Sachse, TX, Dr. Jaison John provides expert diagnosis, treatment, and long-term management of both hepatitis B and hepatitis C. Dr. John completed his gastroenterology fellowship at UT Medical Branch, where he served as Chief Fellow, and his internal medicine residency at UT Austin Dell Medical School, where he served as Chief Resident. He holds dual board certifications from the American Board of Internal Medicine in both internal medicine and gastroenterology.

Hepatitis B (HBV)

Hepatitis B is caused by the hepatitis B virus (HBV), a DNA virus that infects and damages liver cells. Transmission occurs through contact with infected blood or body fluids, including during childbirth (mother-to-child transmission), through sexual contact, sharing of needles, and occupational exposure (needlestick injuries in healthcare workers).

Acute vs. Chronic Hepatitis B

When an adult acquires hepatitis B, approximately 95 percent will clear the virus on their own within 6 months (acute infection). The remaining 5 percent develop chronic hepatitis B. However, the younger the age at infection, the higher the risk of chronicity: up to 90 percent of infants infected at birth develop chronic infection, underscoring the critical importance of the birth-dose hepatitis B vaccine.

Chronic Hepatitis B Management

Chronic hepatitis B is a lifelong condition that requires ongoing medical monitoring and, in many cases, antiviral treatment. The goals of treatment are to suppress viral replication, prevent liver damage, and reduce the risk of cirrhosis and liver cancer. The American Association for the Study of Liver Diseases (AASLD) recommends the following approach:

• Regular monitoring — Patients with chronic hepatitis B require periodic blood tests including HBV DNA (viral load), hepatitis B e-antigen (HBeAg) status, liver enzymes (ALT), and liver function tests. These are typically checked every 3 to 6 months depending on disease phase.
• FibroScan assessment — FibroScan (transient elastography) provides noninvasive measurement of liver stiffness to assess fibrosis severity and track changes over time, reducing the need for liver biopsy.
• Antiviral therapy — First-line antiviral medications include entecavir (Baraclude) and tenofovir (Viread or Vemlidy). These nucleos(t)ide analogues effectively suppress HBV replication in the vast majority of patients and have excellent safety profiles for long-term use. Treatment is typically recommended for patients with elevated viral loads and evidence of liver inflammation or fibrosis. Some patients require lifelong therapy, while others may be able to discontinue treatment under close medical supervision after achieving specific endpoints.
• Hepatocellular carcinoma (HCC) surveillance — Unlike most other liver diseases, hepatitis B can cause liver cancer even in the absence of cirrhosis. The AASLD recommends HCC surveillance with abdominal ultrasound and alpha-fetoprotein (AFP) blood test every 6 months for all patients with chronic hepatitis B who meet specific risk criteria, including Asian men over age 40, Asian women over age 50, African/African American patients, patients with cirrhosis, and patients with a family history of HCC.

Hepatitis B Vaccine

Hepatitis B is the only form of chronic viral hepatitis that is preventable with a vaccine. The CDC recommends hepatitis B vaccination for all infants (beginning with a birth dose), all children and adolescents who were not vaccinated at birth, and all adults aged 19 to 59. Adults aged 60 and older with risk factors should also be vaccinated. The vaccine is safe, highly effective, and provides long-lasting immunity.

Hepatitis C (HCV)

Hepatitis C is caused by the hepatitis C virus (HCV), an RNA virus that is transmitted primarily through exposure to infected blood. The most common routes of transmission include injection drug use (past or present), blood transfusions or organ transplants received before 1992 (before routine screening was implemented), needlestick injuries in healthcare settings, and, less commonly, sexual transmission and mother-to-child transmission during childbirth.

The Silent Epidemic

Hepatitis C is often called the "silent epidemic" because most people with chronic HCV infection have no symptoms for decades. The virus causes a gradual, progressive inflammation of the liver that can lead to fibrosis, cirrhosis, liver failure, and liver cancer over a period of 20 to 30 years. By the time symptoms develop, significant and potentially irreversible liver damage may have already occurred. This is why universal screening is so critical for early detection.

Screening Recommendations

The CDC and the U.S. Preventive Services Task Force (USPSTF) recommend:

• Universal screening — All adults aged 18 and older should be screened for hepatitis C at least once in their lifetime, regardless of risk factors.
• Pregnancy screening — All pregnant women should be screened for hepatitis C during each pregnancy.
• Risk-based screening — More frequent screening for individuals with ongoing risk factors, including people who currently inject drugs, people with HIV, and people who receive long-term hemodialysis.

Screening involves a simple blood test (HCV antibody test). If the antibody test is positive, a confirmatory HCV RNA (viral load) test is performed to determine whether the infection is active.

Hepatitis C Treatment: The Cure

The development of direct-acting antiviral (DAA) medications represents one of the greatest advances in modern medicine. These oral medications target specific steps in the HCV replication cycle and achieve cure rates exceeding 95 percent across all major genotypes of the virus. The medical term for cure is sustained virologic response (SVR), defined as undetectable HCV RNA in the blood 12 weeks after completing treatment.

Current first-line DAA regimens include:

• Sofosbuvir/velpatasvir (Epclusa) — A once-daily, single-tablet regimen effective against all major HCV genotypes. Treatment duration is typically 12 weeks.
• Glecaprevir/pibrentasvir (Mavyret) — A once-daily, single-tablet regimen also effective against all major genotypes. Treatment duration is 8 weeks for most treatment-naive patients without cirrhosis, and 12 weeks for patients with compensated cirrhosis.
• Sofosbuvir/velpatasvir/voxilaprevir (Vosevi) — A triple-combination regimen used primarily for patients who have previously been treated with DAA therapy or who have certain resistance-associated substitutions.

These medications are well-tolerated, with side effects that are generally mild and may include fatigue, headache, and nausea. Unlike older interferon-based therapies, DAAs do not require injections and have far fewer side effects.

The AASLD and the Infectious Diseases Society of America (IDSA) recommend treatment for nearly all patients with chronic hepatitis C, regardless of fibrosis stage, with very few exceptions.

Post-Cure Monitoring

After achieving SVR (cure), patients who had advanced fibrosis (stage F3) or cirrhosis (stage F4) before treatment must continue long-term follow-up, because the risk of liver cancer does not return to zero even after the virus is eliminated. The AASLD recommends:

• Continued HCC surveillance with abdominal ultrasound and AFP every 6 months indefinitely for patients who had advanced fibrosis or cirrhosis.
• FibroScan assessment to monitor liver stiffness over time after cure — many patients experience gradual improvement in fibrosis scores after SVR.
• Screening for reinfection in patients with ongoing risk factors, as cure does not provide immunity against future HCV infection.

FibroScan and Noninvasive Liver Assessment

FibroScan (transient elastography) plays a central role in the evaluation and ongoing management of both hepatitis B and hepatitis C at Texas Gut Health. This noninvasive, painless, office-based test measures liver stiffness, which correlates with the degree of fibrosis (scarring) in the liver. FibroScan helps Dr. John:

• Stage fibrosis at the time of initial diagnosis without requiring liver biopsy in most cases
• Determine whether antiviral treatment for hepatitis B should be initiated
• Assess the urgency of hepatitis C treatment based on fibrosis severity
• Monitor liver stiffness trends over time during treatment and after achieving SVR
• Identify patients who require ongoing HCC surveillance

Liver Cancer Surveillance

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is a major concern for patients with chronic hepatitis B and C, particularly those with advanced fibrosis or cirrhosis. When detected early, liver cancer can be treated with curative intent through surgical resection, liver transplantation, or local ablation therapies. When detected late, the prognosis is significantly worse.

The AASLD recommends HCC surveillance consisting of:

• Abdominal ultrasound every 6 months to visualize the liver and identify suspicious nodules
• Alpha-fetoprotein (AFP) blood test every 6 months as a complementary tumor marker

This surveillance program applies to all patients with hepatitis-related cirrhosis and to patients with chronic hepatitis B who meet specific risk criteria (as outlined above), even if they do not have cirrhosis. It is important to understand that HCC surveillance is a lifelong commitment for qualifying patients — even after hepatitis C cure, the risk of liver cancer persists in patients who had advanced fibrosis or cirrhosis.

Prevention and Public Health

Preventing new cases of viral hepatitis and identifying undiagnosed infections are key public health priorities. Important prevention strategies include:

• Hepatitis B vaccination — The most effective prevention tool available. The CDC's universal vaccination recommendation aims to eliminate new HBV infections.
• Universal screening — Screening all adults for both hepatitis B and C allows identification and treatment of the estimated millions of Americans living with undiagnosed chronic infection.
• Harm reduction — Needle exchange programs, access to treatment for substance use disorders, and education about safe injection practices reduce HCV transmission among people who inject drugs.
• Treatment as prevention — Curing hepatitis C eliminates the virus from the individual, preventing further transmission to others. This "treatment as prevention" approach is a cornerstone of the national strategy to eliminate hepatitis C as a public health threat.

Frequently Asked Questions