Hepatitis at first simply means inflammation of the liver. Behind it there can be alcohol, medicines, autoimmune processes or a fatty liver. In viral hepatitis, it is a virus that specifically attacks the liver cells. Five hepatitis viruses are known, named with the letters A to E.¹
This article focuses on hepatitis B and C, because it is mainly these two that become chronic — that is, they last longer than six months and scar the liver over the years. Hepatitis A and E are usually transmitted through food or water and, in people who are otherwise healthy, generally heal without lasting effects.
Why “curable” applies only to hepatitis C. The hepatitis C virus can be removed from the body completely with modern tablets. The hepatitis B virus, by contrast, deposits a stable copy of its genetic material in the nucleus of the liver cells. Medicines can reliably suppress its multiplication, but can hardly eliminate this reserve. That is why the aim in chronic hepatitis B is usually lasting control, not a cure.²,³
How it differs from fatty liver: raised liver values do not automatically mean a viral infection — far more often, a fatty liver is behind them. Conversely, viral hepatitis should be ruled out when values are raised for no clear reason, because both can be present together. Medicines are also a possible cause, see Medications, kidneys and liver.
2. Hepatitis B and C compared
Both viruses attack the same liver, but they differ in almost everything that matters to you in practice: infection, course, vaccination and treatment.¹
Feature
Hepatitis B
Hepatitis C
Main route of transmission
Sexual contact, blood, from mother to child at birth
Blood-to-blood contact, above all shared needles and equipment; rarely sexual
Chronic course
Rare in adults, but usual in newborns of infected mothers
In the majority of those infected
Vaccination
Yes, a standard vaccination in infancy
No
Treatment of the chronic form
Usually daily tablets for years, less often interferon injections
Tablets, usually for eight to twelve weeks
Curable?
Rarely; the aim is lasting suppression of the virus
Yes, in the great majority of cases
Table scrolls to the right
A special case, hepatitis D: this virus can only multiply together with the hepatitis B virus. An additional hepatitis D infection is usually more severe; the hepatitis B vaccination indirectly protects against it as well.¹,²
3. Symptoms and consequences
The treacherous thing about both infections: they often go unnoticed for years. The inside of the liver has no pain nerves, so it only makes itself felt late.
Acute infection
Many acute infections — in hepatitis C, in fact most of them — cause no symptoms or only vague ones. When symptoms do appear, it is weeks to months after infection:¹
A flu-like feeling of illness with marked fatigue, loss of appetite and nausea
Pressure in the upper right abdomen caused by the swollen liver
Yellowing of the skin and the whites of the eyes — more on this under Jaundice
Chronic hepatitis B or C often causes no symptoms at all, or only an exhaustion that is hard to pin down. Left untreated, it can lead over the years to scarring (fibrosis) and eventually liver cirrhosis — with fluid in the abdomen, bleeding from varicose veins in the oesophagus and a higher risk of liver cancer. With hepatitis B, liver cancer can also develop without prior cirrhosis. Both viruses can also affect organs outside the liver, such as the kidneys, blood vessels, skin and joints.²,³
Emergency: signs of acute liver failure. Rarely, acute hepatitis — above all hepatitis B — is so severe that the liver fails. Rapidly increasing yellowing, drowsiness, confusion, unusual sleepiness, a tendency to bleed such as nosebleeds or bruises for no reason: go to the emergency department immediately or call 112 (emergency number in Germany). The same applies to vomiting blood or black stools if you have known cirrhosis.
4. Transmission and risk factors
Both viruses are transmitted through blood, and hepatitis B also through other body fluids. The main routes are:¹
Shared needles and equipment — the most common route for hepatitis C among people who use drugs, including via shared straws when snorting.
Sexual contact — a main route for hepatitis B in adults. Hepatitis C is rarely transmitted sexually; it is more common with practices that cause injuries or with a simultaneous HIV infection.
Birth — a mother with hepatitis B can pass on the virus at birth if the newborn is not vaccinated straight away. With hepatitis C, transmission to the baby is possible but rare.
Non-sterile procedures and shared personal care items — tattoos or piercings done with poor hygiene; razors and toothbrushes can pass on traces of blood.
Earlier blood products and origin — transfusions before the early 1990s or growing up in regions where the viruses are more widespread are reasons for a test.
Neither virus is transmitted through everyday contact: hugging, shaking hands, eating together, sharing crockery or coughing are no risk.
Medicines as a trigger: hepatitis B reactivation. Hepatitis B that seems to have healed can flare up again if the immune system is strongly suppressed by medicines — for example by certain antibodies against immune cells, chemotherapy, prolonged high-dose cortisone treatment such as with prednisolone, or biologics for rheumatic conditions and inflammatory bowel disease. That is why people are tested for hepatitis B before such treatments and, if necessary, given preventive treatment.² Conversely, medicines themselves can damage the liver and mimic hepatitis — the complete list of medicines is always part of the assessment.
5. Diagnosis: which tests are available
The diagnosis is made with a blood test. What matters is the order in which things are looked for and what the individual values mean:²,³
Liver values (ALT/GPT, AST/GOT): indicate inflammation but are non-specific — and sometimes completely normal in chronic hepatitis.
Hepatitis B screening test: HBsAg (surface antigen) shows a current infection, anti-HBc a past or existing contact, and anti-HBs protection from vaccination.
Hepatitis C screening test: antibodies against HCV show that there has been contact. They remain positive even after the infection has healed — only detecting the virus's genetic material (HCV RNA) proves an active infection.
Viral load and activity: HBV DNA, HBeAg and other markers decide whether hepatitis B needs to be treated.
Ultrasound and elastography: measuring the stiffness of the liver estimates the degree of scarring without a tissue sample. A liver biopsy is only rarely needed today.
Co-infections: with hepatitis B, testing for hepatitis D is also done, and usually for HIV as well.
Testing once is worth it: Check-up 35. People with statutory health insurance aged 35 and over are entitled to a one-off test for hepatitis B and C as part of the health check-up. The background: many chronic infections would otherwise go undetected, even though they could be treated well.⁴
In the past, treating hepatitis C meant months of interferon injections with an uncertain outcome. Today, directly acting antiviral tablets (DAAs, direct-acting antivirals) are available that specifically block the virus from multiplying.³
The result is remarkable: in the great majority of those treated — well over 90 per cent in studies and in routine care — the virus is permanently undetectable after treatment. If no HCV RNA can be found in the blood twelve weeks after the end of treatment, hepatitis C is considered cured.³,⁵ According to the guideline, every chronic hepatitis C infection should in principle be treated, regardless of its stage.
First linePangenotypic combination tablets
Glecaprevir/pibrentasvir
Works against all virus types. For many people who have not been treated before, eight weeks are enough. Not suitable if liver function is severely impaired.
Sofosbuvir/velpatasvir
Also effective against all virus types, usually taken for twelve weeks. Can also be used in advanced cirrhosis, in which case at specialist centres.
If a first treatment has not worked, there are triple combinations for a second course — this is rare. The tablets are generally well tolerated; the most frequently reported effects are headache and tiredness. The real challenge lies elsewhere: in taking every dose without a gap for eight to twelve weeks and in the interactions (see section 8). Which combination is right is decided by the treating practice based on the liver findings, previous treatment and other medicines.
Cured does not mean immune. The antibodies usually remain detectable, but they do not protect against a new infection. And if cirrhosis was present before treatment, ultrasound checks of the liver every six months remain important even after the cure.
7. Hepatitis B: control rather than cure
In adults, acute hepatitis B usually heals on its own and is generally treated only supportively. With chronic hepatitis B the situation is different: not every infection needs treatment. Whether treatment is necessary depends on the viral load, liver values, degree of scarring, age and any family history of liver cancer. Some people need nothing more than regular check-ups for years.²
If treatment is given, the aim is to suppress the multiplication of the virus permanently and so prevent cirrhosis and liver cancer. The best possible result — loss of HBsAg, often called a “functional cure” — is only rarely achieved. To be honest: for most people, hepatitis B treatment is long-term treatment.
First lineNucleos(t)ide analogues as long-term treatment
Entecavir
One tablet a day; depending on the dose, the prescribing information requires it to be taken on an empty stomach, at a distance from meals. Resistance is rare in people who have not been treated before.
Tenofovir (tenofovir disoproxil or tenofovir alafenamide)
One tablet a day, with a meal. With the older form, kidney function and bone health are checked regularly; the newer form puts less strain on both.
AlternativeTime-limited immunotherapy
Pegylated interferon alfa
A weekly injection, usually for 48 weeks. In selected patients a somewhat higher chance of losing HBsAg, but considerably more side effects, such as flu-like symptoms and low moods. Not for advanced cirrhosis or during pregnancy.
With additional hepatitis D: bulevirtide
Blocks the virus from entering the liver cell; injected under the skin every day, used at specialist centres.
Whether and with what treatment is given is always decided by the treating practice — ideally a practice specialising in liver disease.
Never stop hepatitis B tablets on your own. If treatment is interrupted, the virus can start multiplying again within weeks and trigger a severe flare of hepatitis — in a previously damaged liver, even liver failure. This also applies if your values have been good for years. In selected cases, a planned stop under close laboratory monitoring may be considered; that is solely a decision for the specialist practice. More in the guide Stopping medications.
One tablet a day — for years and without a gap?
brite reliably reminds you to take your hepatitis medication and shows you whether you have really not missed a dose.
It is above all the hepatitis C tablets that have a pronounced interaction profile. The most important groups according to the prescribing information:⁵
With glecaprevir/pibrentasvir, a rise in liver values
A different form of contraception for the duration of treatment, such as progestogen-only products
Blood thinners such as phenprocoumon or dabigatran
Clotting values fluctuate as the liver recovers; dabigatran levels can rise
Close monitoring; some combinations are not allowed
Insulin and diabetes tablets
Blood sugar can fall during treatment
Measure more often, adjustment by the practice
Table scrolls to the right
Over-the-counter and herbal medicines are easily forgotten here. The hepatitis B tablets have comparatively few interactions; with tenofovir disoproxil, however, medicines that strain the kidneys should be agreed with the practice.
Reactivation: hepatitis B during immunotherapy
With chronic hepatitis B or a past hepatitis B infection, preventive treatment is given or the viral load is monitored closely before any stronger immunosuppression.² Hepatitis B can also flare up during hepatitis C treatment — which is why testing for both viruses is done beforehand.³,⁵
Painkillers: in cirrhosis, anti-inflammatory medicines such as ibuprofen or diclofenac are problematic; the maximum daily amount of Paracetamol should also be agreed with your doctor. No self-medication without checking first.
9. Vaccination, pregnancy and preventing infection
The hepatitis B vaccination
The German Standing Committee on Vaccination (STIKO) recommends the hepatitis B vaccination for all infants as part of the primary immunisation. Missed vaccinations should be caught up by the 18th birthday. For adults it is recommended when there is an increased risk, for example with chronic liver disease, a weakened immune system, contact with blood at work or close contact with people who have hepatitis B.⁶ With chronic hepatitis B or C, protection against hepatitis A also makes sense — see Vaccinations for adults.
No vaccine against hepatitis C
There is still no vaccine against hepatitis C. Protection means avoiding contact with blood, not sharing equipment and making sure conditions are sterile for tattoos and piercings.
Pregnancy and birth
Testing for hepatitis B is part of antenatal care. If the mother is infected, the newborn receives a combined active and passive vaccination straight after birth; if the viral load is high, antiviral treatment of the mother towards the end of pregnancy may also be considered.²,⁶ The hepatitis C tablets are not approved for use in pregnancy; treatment is usually given before or afterwards. Breastfeeding is usually possible with both infections. More in the guide Medications during pregnancy.
10. Everyday life with chronic hepatitis
Avoid alcohol — it speeds up scarring of the liver considerably. Whether small amounts are acceptable depends on the liver findings; with cirrhosis, the rule is to avoid it completely. More on this in the guide Medications and alcohol.
Your own personal care items — do not share razors, toothbrushes or nail scissors; with hepatitis B, use condoms until your partner has been vaccinated.
Keep your check-up appointments — with cirrhosis and in certain hepatitis B situations, the liver is usually examined by ultrasound for cancer every six months.
Keep a complete list of your medicines — including over-the-counter products, and show it to every practice that prescribes something new; a template is in the guide Keeping a medication list.
For many people, the liver is less of a burden than the worry of infecting others. There is no risk in everyday contact within the family, in sport and in the vast majority of jobs; restrictions mainly concern work in healthcare where there is a risk of injury. If alcohol or drugs are involved, getting help is not a question of morals — see Alcohol dependence.
Viral load, liver values, ultrasound — what was when?
Keep track of lab results and check-up dates over time, instead of gathering them together before every appointment.
Yes, in the great majority of cases. Directly acting antiviral tablets, usually taken for eight to twelve weeks, permanently remove the virus in well over 90 per cent of those treated. If no genetic material from the virus can be detected in the blood twelve weeks after the end of treatment, the infection is considered cured.
In adults, acute hepatitis B usually heals on its own. Chronic hepatitis B, by contrast, can only rarely be cured, because the virus deposits a stable copy of its genetic material in the liver cells. With medicines, however, it can usually be well controlled, so that cirrhosis and liver cancer occur much less often.
Both viruses are transmitted through blood; hepatitis B is also often passed on through sexual contact and from mother to child at birth. Hepatitis C is transmitted mainly through shared needles and equipment or non-sterile procedures. Everyday contact such as hugging, eating together or sharing crockery is no risk.
No, there is still no vaccine against hepatitis C. There is one against hepatitis B, though: the STIKO recommends the vaccination for all infants and catching it up by the 18th birthday, and for adults at increased risk. The hepatitis B vaccination also indirectly protects against hepatitis D.
People with statutory health insurance aged 35 and over are entitled to a one-off test for both viruses as part of the health check-up. If there are symptoms, abnormal liver values, a specific risk of infection or before a treatment that strongly suppresses the immune system, testing is done regardless.
Not on your own. Good values show that the treatment is working, not that the virus has gone. After stopping, it can quickly start multiplying again and trigger a severe flare of hepatitis. A planned stop is only possible in selected cases and under close monitoring by the specialist practice.
Important examples are acid blockers, certain cholesterol-lowering drugs, the heart medicine amiodarone, some anti-epileptic drugs, St John's wort, oestrogen-containing contraceptives with one of the combinations, and blood thinners. What exactly is affected depends on the product — which is why the complete list of medicines needs to be on the table before treatment starts.
Robert Koch Institute (RKI): RKI guides on hepatitis B and D and on hepatitis C. Accessed 2026 — German source. rki.de
German S3 guideline on the prophylaxis, diagnosis and treatment of hepatitis B virus infection, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), 2021 version — German source. awmf.org
German S3 guideline on the prophylaxis, diagnosis and treatment of hepatitis C virus infection, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), updated 2018 version — German source. awmf.org
Federal Joint Committee (G-BA): Health Check-up Directive — screening for hepatitis B and C as part of the check-up. Accessed 2026 — German source. g-ba.de
European Medicines Agency (EMA): Summaries of product characteristics for glecaprevir/pibrentasvir and sofosbuvir/velpatasvir. Accessed 2026. ema.europa.eu
German Standing Committee on Vaccination (STIKO): STIKO recommendations at the Robert Koch Institute, Epidemiologisches Bulletin, current version. Accessed 2026. rki.de/stiko
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Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Rapidly increasing yellowing, confusion, marked drowsiness or a tendency to bleed can point to liver failure and are an emergency — call 112 (emergency number in Germany) straight away. Never stop hepatitis B medicines on your own, and do not take any new medicines during hepatitis C treatment without checking first. The choice of medicine and its dose is always set individually by the treating practice. Last updated: September 2026.
