The Silent Siege on the Liver

When 38-year-old Louise K* went for a regular medical consultation during pregnancy, she was not expecting anything more dramatic than a routine medical review as she followed a healthy lifestyle. Yet she tested positive for Hepatitis C.

Dr Kaiser Raja
Consultant in Liver Diseases, Transplant Hepatology,
Gastroenterology and Advanced Endoscopy

Dr Kaiser Raja, Consultant in Liver Diseases, Transplant Hepatology, Gastroenterology and Advanced Endoscopy, at King’s College Hospital, Dubai says, “She was completely unaware of it. If she had not turned pregnant, she would not have undergone a test that revealed her liver issue.”

That, perhaps, is the most dangerous thing about liver disease: its silence. While heart disease announces itself with pain and panic, the liver often deteriorates quietly, cell by cell, over years. A person may feel perfectly healthy even as inflammation, scarring and irreversible damage slowly unfold inside the body. This silent epidemic is intersecting with modern urban lifestyles in alarming ways caution doctors.

Understanding Hepatitis

“Hepatitis simply means inflammation of the liver,” explains Dr Raja. “Alcohol, excess fat, certain medications, supplements, hormones, can cause hepatitis. In the light of the upcoming World Hepatitis Day, we can focus viral hepatitis, which remains one of the world’s major hidden health threats, especially because many patients remain symptom-free for years.”

There are five major hepatotropic or liver-targeting viruses Hepatitis A, B, C, D and E. Among them, Hepatitis A and E are typically acute infections spread through contaminated food and water. They are more common in regions where sanitation and hygiene are challenges.

Symptoms can be dramatic: fatigue, nausea, vomiting, loss of appetite, fever, jaundice, dark urine and itching. Yet most patients, with prompt medical advice, recover fully within weeks.

“The good news is that about 99 per cent recover without specific treatment,” says Dr Raja. “Good hydration, nutrition and supportive care are usually enough.”

In countries with strong public health systems, acute viral hepatitis is now relatively rare, say experts. Vaccination has also played a major role. Hepatitis A vaccines are now routinely given to children, and Hepatitis E vaccines are also nearing wider availability.

The larger concern today, however, lies elsewhere.

The silent epidemic

Unlike Hepatitis A and E, Hepatitis B and C are often chronic infections. They spread through infected blood and bodily fluids, including unsafe sexual contact, contaminated needles, tattoos, intravenous drug use, unsafe medical procedures and, in the case of Hepatitis B, mother-to-child transmission during childbirth. Once they enter the body, they can remain there for decades.

“The liver has enormous reserve capacity,” explains Dr Raja. “The virus may destroy small numbers of liver cells every day, but the liver regenerates continuously. This ability to silently compensate is precisely what makes chronic liver disease dangerous as patients feel normal.

How does the jab help?

A patient may experience vague symptoms, but nothing alarming enough to trigger medical attention even as the virus continues damaging the liver over several years, eventually causing fibrosis, cirrhosis and even liver cancer.

This is why universal vaccination against Hepatitis B is so important. Today, most countries vaccinate newborns against Hepatitis B within the first year of life. The World Health Organization also recommends that everyone should be tested for Hepatitis B and C at least once in their lifetime, especially those from high-risk regions or those with abnormal liver tests.

Globally, Hepatitis B remains particularly common in parts of Southeast Asia and Africa. Hepatitis C, meanwhile, became widespread in areas linked historically to unsafe injection use, intravenous drug use and contaminated medical practices.

Unlike Hepatitis B, there is no vaccine for Hepatitis C. However, modern antiviral medications have transformed treatment. Today, direct-acting antiviral drugs can cure Hepatitis C in more than 95 to 99 per cent of patients within about three months, says the doctor.

This is why global health agencies are pushing aggressively for testing and treatment, with the goal of eliminating Hepatitis C as a public health threat.

In the UAE, Dr Raja says one misconception surrounds so-called “silent” Hepatitis B infections. Some patients are told they are merely “carriers” and assume they can safely ignore the condition.

“That is risky,” says Dr Raja. “The virus can reactivate years later.”

Immune system changes triggered by pregnancy, chemotherapy, long-term steroid use or modern biological drugs used for asthma, rheumatoid arthritis and autoimmune disorders can suddenly awaken dormant infection.

“If somebody starts cancer treatment without detecting Hepatitis B or C first, the virus can flare aggressively and cause liver failure during treatment,” he says.

Fatty liver disease

Fatty liver disease which is driven by obesity, diabetes, abdominal fat, sedentary lifestyles and insulin resistance, has exploded worldwide.

Dr Raja estimates that nearly two out of three people today may have some degree of fatty liver.

Liver disease is rarely caused by one thing anymore,” he says. “A patient may have fatty liver, alcohol use and Hepatitis B or C all together. They work like a cocktail on the liver.

He recalls one particularly striking patient – a 32-year-old man with advanced cirrhosis caused by Hepatitis C. The case was unusual because he was relatively young and the disease was in a severely advanced stage.

But the patient had been obese since childhood, later developed alcohol use habits and then contracted Hepatitis C. Despite dramatic weight loss and treatment, the cirrhosis remained with lifelong risk of liver cancer.

Dispelling common myths

Dr Raja dispels the fear that people have about contracting liver disease through social contact.

“You cannot get Hepatitis B or C through casual contact,” he says. “Not through shaking hands, sharing food or using the same utensils.”

Meanwhile, vaccination remains one of the greatest public health successes against Hepatitis B, with newborn immunization programs now widespread globally.

Liver health is often neglected even as people focus on diabetes cholesterol and heart disease, says Dr Raja. That is why regular liver health checks matter.

He advises adults, especially after the age of 25, to have their liver evaluated every three to five years.

His advice is simple: do not wait for symptoms, check before the damage begins speaking for itself.