By 2026, we know more about hepatitis B and C than ever before - but millions still don’t know they’re infected. These two viruses attack the liver silently, often for decades, before causing cirrhosis, liver failure, or cancer. The good news? We have tools to stop them. The bad news? Many people still don’t get tested, don’t get treated, or don’t even know where to start.

How Hepatitis B and C Spread - And What Doesn’t Spread Them

Hepatitis B and C are not the same virus, but they share one dangerous trait: they spread through blood and bodily fluids. That’s it. No sneezing. No hugging. No sharing a coffee cup.

For hepatitis B, the biggest risk is from mother to baby during childbirth. In places like parts of Asia and Africa, where hepatitis B is common, up to 90% of chronic infections start this way. That’s why the first dose of the hepatitis B vaccine is given within 24 hours of birth - it cuts transmission by over 95%.

Sexual contact is another major route. If you’re sexually active with someone who has hepatitis B and you’re not vaccinated, your risk of catching it is 30-60%. Sharing needles - whether for drugs, tattoos, or piercings - is just as risky. Even sharing a razor or toothbrush can spread it, because tiny amounts of blood can carry the virus. Hepatitis B can survive on surfaces for up to seven days. That’s why hospitals and clinics have strict protocols.

Hepatitis C spreads almost entirely through blood. The biggest driver today? The opioid crisis. In the U.S., over two-thirds of new hepatitis C cases happen in people under 40 who inject drugs. Needle sharing, dirty equipment, even reusing cotton filters - all can spread the virus. It’s also passed from mother to child in about 5-6% of pregnancies, though this risk goes up if the mother has HIV too.

And here’s what you don’t need to worry about: toilet seats, doorknobs, food, water, or casual contact. You can’t catch hepatitis B or C from a handshake, a kiss, or eating at the same restaurant as someone who has it.

Who Should Be Tested - And When

Testing is the first step to stopping these viruses. But many people don’t get tested because they feel fine. That’s the problem. Both viruses can live in your body for years without symptoms.

For hepatitis B, the CDC now recommends one-time screening for all adults - no exceptions. If you’re pregnant, you’ll be tested automatically. If you’re a healthcare worker, have HIV, use injectable drugs, or had a blood transfusion before 1992, you need testing too. People from countries where hepatitis B is common - like China, Southeast Asia, Sub-Saharan Africa - should be tested even if they were born here.

Hepatitis C testing is even simpler: everyone 18 and older should get tested at least once. That’s the official recommendation as of 2024. Pregnant women are screened during every pregnancy. If you’ve ever injected drugs - even once, decades ago - you need a test. Same if you’ve had long-term dialysis, received a blood transfusion before 1992, or have abnormal liver enzymes.

Testing for hepatitis B uses a blood panel: HBsAg (to find active infection), anti-HBc (to see if you’ve ever been exposed), and anti-HBs (to check if you’re immune from vaccination or past infection). For hepatitis C, it starts with an antibody test. If that’s positive, a follow-up RNA test confirms whether the virus is still active.

There are now rapid tests - like the OraQuick HCV test - that give results in 20 minutes using just a finger prick. These are used in clinics, harm reduction centers, and even some pharmacies. Point-of-care hepatitis B tests are also getting better, with over 98% accuracy in field studies.

What’s New in Hepatitis C Treatment

Hepatitis C used to be a life sentence. In the 1990s and early 2000s, treatment meant weekly injections of interferon, lasting up to 48 weeks, with brutal side effects: depression, fatigue, fever, and sometimes permanent damage. Cure rates? Around 40-50%.

That changed in 2013 with the approval of sofosbuvir, the first direct-acting antiviral (DAA). Today, DAAs like Epclusa (sofosbuvir/velpatasvir) and Mavyret (glecaprevir/pibrentasvir) are the standard. They’re pills. Taken once a day. For just 8-12 weeks. Side effects? Usually mild - maybe a headache or tiredness.

The cure rate? Over 95%. For every 100 people treated, 95+ are cleared of the virus for life. That’s not remission. That’s a cure. The virus doesn’t come back.

And the cost? It’s dropped hard. In 2014, a full course of sofosbuvir cost $84,000. Today, in the U.S., it’s $24,000-$30,000. In low-income countries, generic versions cost under $300. Egypt cut its hepatitis C rate from 14.7% in 2008 to 0.9% in 2021 by screening millions and offering low-cost treatment nationwide.

But here’s the catch: only 21% of people with hepatitis C in the U.S. got treated in 2020. Why? Lack of testing, stigma, insurance barriers, and not knowing where to go. Even with a cure available, the virus keeps spreading because people don’t know they have it.

What’s New in Hepatitis B Treatment - And Why There’s Still No Cure

Hepatitis B is trickier. We have a vaccine, but no cure. Once you have chronic hepatitis B, you’re usually on medication for life.

The two main drugs are tenofovir alafenamide (TAF) and entecavir. Both suppress the virus, prevent liver damage, and lower the risk of liver cancer. They’re taken as a daily pill. Side effects? Minimal. They’re safe for long-term use.

But they don’t eliminate the virus. They just hold it down. About 1-2% of people on treatment each year naturally lose the hepatitis B surface antigen (HBsAg) - the marker of infection. That’s called a “functional cure.” It’s rare, but it happens.

Now, there’s hope. New drugs are in trials. siRNA therapies like JNJ-3989 silence the virus’s genetic material. Capsid assembly modulators stop the virus from building new copies. Therapeutic vaccines are being tested to wake up the immune system to fight the virus on its own.

One big change in 2025 guidelines: doctors now consider treating adolescents in the “immune tolerant” phase - the stage where the virus is high but the liver looks fine. If they have a family history of liver cancer, diabetes, or fatty liver disease, treatment might start earlier.

And for people with HIV and hepatitis B co-infection, guidelines now require starting hepatitis B treatment at the same time as HIV meds - especially if they’re taking cabotegravir/rilpivirine. Skipping this can lead to drug resistance.

The Big Gaps - Why We’re Not Winning Yet

We have the tools. So why are hepatitis-related deaths projected to rise by 24% by 2025?

First, hepatitis B vaccine coverage is still too low. In the U.S., only 66.5% of adults got all three doses. The goal is 90%. In low-income countries, birth-dose coverage is under 50% in many places.

Second, hepatitis C treatment access is unequal. In rural areas, in prisons, among homeless populations - testing and treatment are hard to reach. Even though DAAs are cheap in bulk, pharmacies and clinics don’t always stock them. Insurance companies still put up hurdles.

Third, stigma kills. People who inject drugs are often treated as “deserving” of hepatitis C. That’s wrong. It’s a disease, not a moral failure. People who got it from a blood transfusion in the 1980s? They’re not to blame. Stigma keeps people from getting tested.

And fourth, we’re not thinking globally. The WHO wants 90% of people to know their status and 80% to be treated by 2030. We’re nowhere near that. Without massive scaling of testing and treatment - especially in Africa and Asia - we won’t meet the goal.

What You Can Do Right Now

If you’re over 18, get tested for hepatitis C. It takes five minutes. If you’ve never been vaccinated for hepatitis B, get the three-shot series. It’s safe, effective, and lasts for life.

If you’re pregnant, ask for your hepatitis B test. If you’ve ever injected drugs, even once, get tested for both. If you’re a healthcare worker, make sure you’re vaccinated and know your status.

And if you’re diagnosed - don’t panic. Hepatitis C can be cured. Hepatitis B can be managed. Your liver can heal. You can live a full, normal life.

The biggest threat isn’t the virus. It’s silence. Talk to your doctor. Get tested. Know your status. That’s how we end this.