Hepatitis B and Hepatitis C Treatment in Fort Smith

What are hepatitis B and hepatitis C?

Hepatitis B and hepatitis C are viral infections that live in the liver and cause inflammation there. Over years, that ongoing inflammation can lead to scarring, and in some people to cirrhosis or liver cancer. The most important thing to know is how differently they are treated today. Hepatitis C can now be cured in most patients with 8 to 12 weeks of well-tolerated pills. Hepatitis B usually cannot be cured yet, but it can be controlled and monitored so the liver stays protected for the long run. Both infections are famously quiet. Many people carry hepatitis B or C for decades with no symptoms at all, and only learn about it from a blood test or from elevated liver enzymes found on routine bloodwork. At Digestive & Liver Center of Arkansas, Dr. Ihab Herraka evaluates, treats, and monitors viral hepatitis for patients throughout Fort Smith and the River Valley. He is a member of the American Association for the Study of Liver Diseases.

How hepatitis B and hepatitis C spread

Both viruses spread through blood and, for hepatitis B, through other body fluids. Neither is spread by hugging, sharing a meal, coughing, sneezing, or using the same bathroom. Hepatitis C spreads mainly through blood-to-blood contact. Common routes include sharing needles or other drug equipment, tattoos or piercings done with unsterile equipment, a blood transfusion or organ transplant received before 1992, needlestick injuries in healthcare work, and, less often, from mother to baby at birth or through sexual contact. Hepatitis B spreads through blood, semen, and other body fluids. Common routes include sexual contact, sharing needles, sharing razors or toothbrushes, and transmission from mother to baby at birth. Worldwide, birth transmission is the most common route, which is why many adults with hepatitis B have had it since childhood without knowing. Knowing how you were exposed is helpful, but it is not required. Many patients never identify a clear source, and that does not change the plan.

Symptoms and who should be screened

Most people with chronic hepatitis B or C feel completely normal. When symptoms do appear, they are usually vague: tiredness, mild pain in the upper right abdomen, poor appetite, joint aches, or nausea. Yellowing of the eyes or skin, swelling in the legs or belly, and confusion are signs of advanced disease and need prompt medical attention. Because symptoms come so late, screening is done by risk, not by how you feel.

• The CDC recommends that every adult 18 and older be tested at least once for hepatitis C, and more often if you have ongoing risk factors. Testing is also recommended with each pregnancy.
• The CDC recommends that all adults be tested at least once for hepatitis B, using a three-part blood panel that shows whether you have the infection, are immune, or need vaccination.
• Testing should be repeated regularly for anyone who injects drugs, receives hemodialysis, is living with HIV, or has ongoing exposure.
• Talk with us sooner if you were born to a mother with hepatitis B, have a household or sexual partner with either virus, were incarcerated, received blood products before 1992, or come from a part of the world where hepatitis B is common. Screening is a simple blood draw. A positive antibody test is followed by a confirmatory test that shows whether the virus is actually present now, since some people clear hepatitis C on their own and keep the antibody for life.

Why hepatitis C is now curable

Hepatitis C treatment changed completely in the last decade. Older interferon injections, with their long courses and difficult side effects, have been replaced by direct-acting antivirals, or DAAs. These are pills, usually taken once a day for 8 to 12 weeks. They attack the virus directly at several points in its life cycle. Most patients tolerate them well; the side effects people report most often are mild headache and tiredness. With current regimens, more than 95 percent of patients who complete a full course are cured, across most genotypes and including many people who have already developed scarring. No treatment works for everyone, and your own likelihood depends on your specific situation, but these are among the most effective therapies in modern medicine. Cure has a precise definition. Twelve weeks after your last pill, we check your blood again. If the virus is undetectable at that point, the infection is considered cured, and it does not come back on its own. Curing hepatitis C lowers your risk of cirrhosis and liver cancer. If scarring is already present, that risk drops but does not disappear, so patients with advanced fibrosis continue monitoring even after cure.

How hepatitis B is controlled and monitored

Hepatitis B works differently. The virus hides inside liver cells in a form that current medicines cannot remove, so for most people the goal is control rather than cure. Control works well. Daily antiviral pills such as tenofovir or entecavir suppress the virus to very low or undetectable levels, calm the inflammation, and lower the long-term risk of cirrhosis and liver cancer. They are generally well tolerated. Not everyone with hepatitis B needs medication right away. The decision depends on your viral load, your liver enzymes, your fibrosis stage, your age, and your family history. Some patients are monitored for years without treatment, and that is an active plan, not neglect. Everyone with hepatitis B needs ongoing follow-up, usually every 6 to 12 months, with lab work and periodic liver imaging. Patients at higher risk of liver cancer, including those with cirrhosis, are typically offered an ultrasound about every six months to catch any problem early. One safety point matters a great deal: never stop hepatitis B medication on your own. Stopping abruptly can trigger a serious flare. Any change should be planned with your physician.

What treatment looks like, step by step

• Confirming the diagnosis. We verify that the virus is truly present with a viral load test, and check which type of hepatitis C you have when it affects treatment choice.
• Checking your liver. We review liver enzymes, bilirubin, albumin, INR, and platelets, and measure scarring with FibroScan liver testing, a painless in-office scan that stages fibrosis from F0 to F4 in about 10 minutes. Your stage shapes both treatment and how long you need monitoring.
• Screening for the other virus. Anyone starting hepatitis C treatment is tested for hepatitis B first, because treating C without checking B can allow a hepatitis B flare. This step is standard and it is not optional.
• Reviewing your medications. Some common drugs, including certain heartburn, cholesterol, and heart rhythm medicines, interact with hepatitis C antivirals. We go through your full list, including supplements, before you start.
• Treatment and check-ins. You take your pills daily and we monitor you during the course, then confirm the result with blood tests after you finish.
• Follow-up. After a hepatitis C cure with no significant scarring, routine liver follow-up may be all you need. With advanced fibrosis or cirrhosis, surveillance continues for life. Many patients also have fat in the liver alongside the virus, which speeds up damage. We treat both together, which is why fatty liver care and MASH and fibrosis treatment sit in the same program as viral hepatitis.

Preventing hepatitis, and protecting the people around you

Hepatitis B is preventable with a safe, effective vaccine. The CDC recommends it for all adults age 19 through 59, and for older adults with risk factors. Household members and sexual partners of someone with hepatitis B should be tested and vaccinated if they are not already immune. There is no vaccine for hepatitis C, so prevention means avoiding blood exposure: do not share needles or drug equipment, do not share razors, toothbrushes, or nail clippers, and use licensed tattoo and piercing shops. Being cured once does not make you immune, so reinfection is possible if exposure continues. A hepatitis A vaccine is also available, and we often recommend it for patients who already have chronic liver disease. If you have either virus, protecting your liver also means limiting or avoiding alcohol (our alcohol liver disease doctor Fort Smith page has more on why this matters), using acetaminophen only at labeled doses, and telling any new provider about your diagnosis.

Why see a GI and hepatology office instead of an infectious-disease clinic

Hepatitis B and C are viral infections, but the damage they do is liver damage, and that is the part an infectious-disease clinic is not set up to stage or manage long term. Here, the physician who treats your virus is the same one who stages your fibrosis with FibroScan, manages fatty liver if it is also present, and watches for cirrhosis and liver cancer risk for as long as you need follow-up. You are not handed off between offices for the infection and the liver; both are tracked in one place, by one physician, over years.

Cost & insurance

Hepatitis screening blood tests, office visits, and medically indicated FibroScan testing are covered by most major plans, including Medicare, Arkansas Medicaid, Oklahoma Medicaid and most major commercial plans (full list). Hepatitis C antivirals are covered by most plans today, including Arkansas Medicaid and Medicare, though many require a prior authorization first. Our office handles that paperwork, submits the required documentation, and follows up with your plan. Manufacturer assistance programs are available for some patients, and our team can help you apply. Self-pay pricing is available for elective services, and our staff verifies your benefits before your visit so there are no surprises. In most cases you do not need a referral. If your plan requires one, we will help you coordinate it. You can also reach our team through our contact page.

Get tested and treated in Fort Smith

If you have never been screened for hepatitis B or C, or you have a positive test and no clear plan, we can help. Dr. Ihab Herraka is board-certified in gastroenterology, internal medicine, and obesity medicine, and he sees patients from Fort Smith, Van Buren, Greenwood, Alma, Barling, Charleston, and Poteau and Sallisaw in eastern Oklahoma. Arabic and English are both spoken in our office. Call Digestive & Liver Center of Arkansas at (479) 242-2888 to arrange screening or treatment, or come to 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 a.m. to 5:00 p.m. In most cases no referral is needed.