In conversation with Editor Ankur Sharma, The News Strike, Vibhor Borkar, Gastroenterologist, Hepatologist and Liver Transplant Physician, warned that Hepatitis C often remains undetected for decades because it silently damages the liver before symptoms appear, allowing progressive fibrosis, cirrhosis, and liver cancer to develop unnoticed. Highlighting India's estimated 5.5 million chronic Hepatitis C cases, Dr. Borkar stressed that infections are not limited to traditional high-risk groups and can also result from everyday exposures such as reused razors at barber shops, unsafe injections, poorly sterilized dental procedures, unregulated tattoos and piercings, and sharing personal grooming items, underscoring the need for greater awareness, early screening, and safe hygiene practices.
Q1- Why does Hepatitis C often remain undetected for years or even decades, and what damage can occur during that silent period?
Hepatitis C remains undetected because the virus replicates quietly in liver cells without provoking strong immune responses, establishing a chronic infection in ~80% of cases. During the silent years, the acute phase (first 6 months) passes with little or no symptoms. The chronic phase follows, where ongoing inflammation causes slow fibrosis (scarring) over 20–30 years. This gradually leads to cirrhosis—permanent structural liver damage—and eventually hepatocellular carcinoma, significantly raising mortality and progression risks—especially for India's predominant genotype 3, which carries the highest threat. Alarmingly, this entire cascade occurs without noticeable symptoms; fatigue, brain fog, or mild abdominal pain are easily dismissed, while jaundice, leg swelling (edema), or abdominal fluid (ascites) appear only after the liver is severely compromised. India bears a heavy burden—~5.5 million chronic cases, ranking among the top 10 globally. Community prevalence is ~0.5% (Delhi ~0.32% in NFHS‑4 data), but high-risk groups—intravenous drug users, hemodialysis patients, and HIV‑positive individuals—show alarming rates up to 44.7%.
2. What everyday exposures—outside of traditional high-risk categories—may increase the risk of infection among younger adults?
In India—and especially Mumbai—everyday exposures, not just drugs or sex, pose risks to younger adults. Key routes include: barber shops (reused razors transmitting via nicks/cuts); unsafe injections (>60% reuse syringes in rural/small clinics); blood transfusions (pre-June 2001, before mandatory screening); dental procedures (poor sterilization in budget clinics); unregulated tattoos/piercings (rising among youth); and shared personal items (razors, toothbrushes, nail clippers with micro-blood). HCV is strictly blood‑borne, requiring blood‑to‑blood contact—not food, water, hugs, or coughs. Sexual contact carries risk only if blood is involved (e.g., menstruation/trauma), distinguishing it from water‑borne Hep A/E and multi‑route HIV.
3. How significant are concerns around unregulated tattoo studios, shared grooming tools, or cosmetic procedures?
Urban lifestyles significantly increase risk—especially with Mumbai's tattoo/microblading boom. In regulated studios with disposable needles, autoclave sterilization, and single-use ink cups, risk is negligible. But many unregulated studios cut corners; reused needles or guns—even with brief "cleaning"—are dangerous because HCV survives outside the body for up to 16 hours. The same applies to cosmetic procedures (permanent makeup, manicures) if equipment isn't properly sterilized. Look for: sealed needles opened in front of you, autoclave use, disposable cups, and gloved staff. If they rely on "rinsing" or "alcohol wipes," walk away. Shared grooming tools—razors, trimmers, nail clippers—in gyms, salons, or hostels also pose risk, as the virus lingers in dried blood for hours. A tiny nick from a shared razor can expose you the next day.
4. Who should consider getting screened for Hepatitis C, even if they believe they have no obvious risk factors?
In my view, the question is now: "Who shouldn't get screened?" Here is my practical list. High Priority: Anyone who had a blood transfusion before 2001—this is non-negotiable. Those with surgeries in smaller or rural hospitals where blood screening was lax. Hemodialysis patients. Current or past injection drug users—even once. Individuals with HIV or Hepatitis B (co-infection is common). Unexplained elevated liver enzymes. Family members of HCV patients (rare but possible via shared grooming items).
Moderate Priority: Tattoos or piercings in unregulated settings. Dental work in India within the last 20 years—many clinics lack proper sterilization. Any hospitalization in India—up to 10% involve unsafe injections. Healthcare workers with potential needlestick injuries.
Low Priority: Anyone over 40 (risk increases with age). Multiple sexual partners (less common but possible with blood exposure). The 30–54 age group—half of chronic infections occur here.
5. How have advances in antiviral treatment changed outcomes for patients diagnosed today?
The game-changer: Directly acting Antivirals (DAA) has replaced the brutal Interferon+ Ribavirin regimen of the past. That older therapy required 24–48 weeks, caused flu-like symptoms, severe depression, anemia, and extreme fatigue—many couldn't complete it. It cured only 40–50% for genotype 3 (India's most common) and cost lakhs of rupees, out of reach for most. Since 2014, Direct-Acting Antivirals directly block the virus's replication machinery. Key Advances:
Cure Rate: Over 95% . Not control. Not suppression. Cure.
Duration: 8–12 weeks. Two to three months of pills.
Side Effects: Minimal—mild headache, fatigue. Nothing like the Interferon days.
India manufactures generics like sofosbuvir, velpatasvir, ledipasvir, and daclatasvir, costing ~₹25,000–30,000 for a full course, and the NVHCP provides them free at government centers. Indian real-world data is world-class: Dr Dhiman's study (91.2% cure in 48,088 patients in Punjab), Dr Gupta ’s study (95.9% cure in 490 patients in New Delhi), and Dr Mehta's study (98.1% cure in 648 patients in New delhi )—matching US/European cohorts. The difference? Our treatment is far more accessible and affordable. For patients, this means a definitive cure. Early detection prevents progression to cirrhosis and liver cancer; even those already with cirrhosis benefit and have reduced cancer risk. Genotype is no longer a major concern, as pan-genotypic drugs cover genotype 3 effectively. Challenges persist: ~15% patient default rates, pandemic-related disruptions (a 1-year delay could cause 72,000 extra deaths globally), need to update pediatric guidelines (WHO recommends DAAs for children aged 3 and above), limited reflex HCV-RNA testing capacity.
