Question 1

What are the different types of viral hepatitis?

Accepted Answer

Five main hepatitis viruses cause different diseases: Hepatitis A (HAV) — spread faeco-orally, acute self-limiting, vaccine preventable; Hepatitis B (HBV) — spread through blood/sex/perinatal, chronic in 90% if infected as infants, vaccine preventable; Hepatitis C (HCV) — spread primarily through blood, chronic in 75-85%, no vaccine but curable with DAAs; Hepatitis D (HDV) — only infects people with HBV, severe disease, prevented by HBV vaccine; Hepatitis E (HEV) — spread faeco-orally, usually self-limiting but dangerous in pregnancy.

Question 2

How is hepatitis B transmitted and prevented?

Accepted Answer

HBV is transmitted through blood (unsafe injections, needlestick injuries, sharing injecting equipment), sexual contact, and from mother to child during birth (perinatal transmission). The hepatitis B vaccine — safe, effective and inexpensive — provides lifelong protection. WHO recommends universal infant vaccination (including a birth dose within 24 hours) and vaccination of healthcare workers and other high-risk adults. Birth-dose vaccination within 24 hours prevents perinatal transmission in >90% of cases.

Question 3

Is hepatitis C curable?

Accepted Answer

Yes — this is one of the most significant medical advances of the past decade. Direct-acting antivirals (DAAs) cure hepatitis C in over 95% of people with 8-12 weeks of oral treatment, with minimal side effects. Pan-genotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) work across all 6 HCV genotypes. The main barriers to elimination are diagnosis (only 21% of people with HCV know their status) and treatment access (DAA pricing in high-income countries remains a barrier despite generic availability in LMICs).

Question 4

Why does HBV infection in infancy cause chronic disease?

Accepted Answer

When hepatitis B virus infects an infant perinatally, the immature immune system cannot mount an effective response and tolerates the virus. Approximately 90% of perinatally infected infants develop chronic HBV infection. In contrast, only 5% of adults infected with HBV develop chronic infection — healthy adult immune systems clear it in 95% of cases. This is why the birth-dose HBV vaccine — preventing perinatal transmission — is so critical. Untreated chronic HBV leads to cirrhosis in 20-30% and hepatocellular carcinoma in a significant proportion.

Question 5

How does viral hepatitis cause liver cancer?

Accepted Answer

HBV and HCV cause liver cancer (hepatocellular carcinoma) through chronic inflammation and cirrhosis, direct integration of HBV DNA into hepatocyte genomes (a mutagenic mechanism), and immune-mediated hepatocyte damage that drives cellular regeneration and mutation accumulation. HBV and HCV together cause approximately 80% of all hepatocellular carcinoma globally. Annual HCC surveillance (ultrasound every 6 months) is recommended for all people with cirrhosis. HBV vaccination and HCV DAA treatment are the most effective prevention strategies.

Question 6

What is Georgia's hepatitis C elimination programme?

Accepted Answer

Georgia launched the world's first national hepatitis C elimination programme in April 2015 — a public-private partnership between the Georgian government, the US CDC, and Gilead Sciences (which provided sofosbuvir free of charge). The programme used birth cohort testing, treatment-as-prevention and integration with harm reduction. Over 60,000 patients had been treated by 2021, with HCV prevalence dropping from approximately 5.4% to 3.2%. Georgia's programme became a global model for HCV elimination in middle-income countries.

Question 7

What is WHO's 2030 viral hepatitis elimination target?

Accepted Answer

The WHO Global Health Sector Strategy on Viral Hepatitis targets by 2030: 90% reduction in new HBV infections; 90% reduction in new HCV infections; 65% reduction in hepatitis-related mortality; 90% of people with HBV and HCV diagnosed; and 80% of eligible people receiving treatment. These targets align with the broader SDG 3.3 target to combat hepatitis by 2030. Current progress is severely off-track for most targets.

Question 8

How is hepatitis B treated?

Accepted Answer

Chronic HBV is not curable with current treatment but can be effectively suppressed. First-line treatment is tenofovir or entecavir — oral nucleotide/nucleoside analogues that suppress HBV replication to undetectable levels, preventing progression to cirrhosis and liver cancer. Treatment is often lifelong. Not everyone with chronic HBV needs immediate treatment — WHO guidelines identify who should be prioritised based on ALT levels, viral load and liver fibrosis assessment.

Question 9

What is hepatitis D (HDV) and why is it dangerous?

Accepted Answer

Hepatitis D virus (HDV) is a defective RNA virus that can only infect people who already have hepatitis B — it requires the HBV surface antigen for its envelope. HBV-HDV co-infection causes the most severe form of viral hepatitis, with faster progression to cirrhosis and a higher risk of hepatocellular carcinoma. HBV vaccination prevents HDV infection by preventing HBV. Bulevirtide — approved by the EMA in 2020 — is the first specific treatment for chronic HDV.

Question 10

Why is hepatitis B birth-dose vaccination coverage still low?

Accepted Answer

Despite being WHO policy since 1992, the HBV birth-dose vaccination rate was only 45% globally in 2022 — far below the target. Barriers include: birth occurring outside facilities (home deliveries cannot receive an injectable vaccine easily); cold chain requirements for vaccine storage; lack of integration of birth-dose into delivery protocols; and programme prioritisation gaps. Sub-Saharan Africa has the world's highest HBV burden but some of the lowest birth-dose coverage rates.

Question 11

What is hepatitis E and who is at risk?

Accepted Answer

Hepatitis E virus (HEV) is transmitted faeco-orally through contaminated water — similar to hepatitis A. It typically causes acute self-limiting hepatitis. However, HEV genotype 1 and 2 are associated with fulminant hepatitis in pregnant women, with case-fatality rates of 20-25% in the third trimester. It causes major outbreaks in refugee camps and conflict-affected settings with poor WASH. A vaccine is licensed in China but not internationally. Improving water and sanitation is the primary prevention strategy.

Question 12

How does GMJ News cover hepatitis?

Accepted Answer

GMJ News tracks WHO global hepatitis data, Georgia's national HCV elimination programme progress, DAA access policy, HBV birth-dose coverage and viral hepatitis as a liver cancer driver. Georgia's pioneering HCV programme gives the Georgian Medical Journal a unique perspective on viral hepatitis elimination and is a source of direct editorial expertise.

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