Despite advancements in medical science, millions of people across the world continue to live with undiagnosed liver conditions, particularly chronic hepatitis B and C. According to the World Health Organization (WHO), an estimated 304 million people are currently infected with these viruses—254 million with hepatitis B and 50 million with hepatitis C. What’s even more alarming is that 1.3 million people die every year from hepatitis-related causes, which breaks down to more than 3,500 deaths each day.
India alone shoulders a massive portion of this global burden, accounting for over 11.6% of the total cases. Around 29.8 million Indians live with hepatitis B, and another 5.5 million are infected with hepatitis C. While these figures should ring alarm bells across healthcare institutions and government departments, the reality on the ground is far more muted. Most individuals suffering from liver disease remain unaware of their condition until severe complications like cirrhosis, liver failure, or liver cancer develop. Medical experts say this is due to a combination of vague early symptoms, lack of regular screening, social stigma, and limited public awareness.
So, how does a disease so widespread manage to remain under the radar for so long?
One of the core issues is the subtlety of early symptoms. As Dr. Vivekanandan Shanmugam, Lead Liver Transplant Surgeon at SIMS Hospital, Chennai, explains, “In the early stages, liver trouble may show up as fatigue, appetite loss, or mild abdominal discomfort—symptoms that are easily brushed aside or misattributed to other minor illnesses.” Even when more specific signs appear, such as dark-colored urine or yellowing of the eyes, they’re often neglected or self-treated without proper diagnosis.
What makes liver diseases even more dangerous is their capacity to progress silently. Hepatitis B and C are particularly insidious because they do not always produce noticeable symptoms in their early or even middle stages. It is only when the liver is significantly damaged that people begin to experience more obvious issues like jaundice, swelling of the abdomen or legs, unexplained bleeding, or confusion—all signs of advanced liver disease. By that time, treatment options become more limited and complex.
The mode of transmission also contributes to the stealthy spread of these diseases. Unsafe injections, contaminated blood transfusions, sexual contact, and mother-to-child transmission during childbirth are among the most common ways hepatitis viruses are transmitted. Yet, public knowledge about these pathways remains shockingly low. While urban centers may benefit from some degree of health literacy and access to care, the situation in rural and semi-urban India is far more dire, where access to diagnostics and hepatology services is minimal or non-existent.
Screening remains the cornerstone of early detection, yet it is far from routine. As Dr. Shanmugam points out, screening for hepatitis B and C is recommended for several high-risk groups—those who received blood transfusions before the 1990s, patients on dialysis, healthcare workers, pregnant women, and individuals living with HIV. However, these recommendations are often not followed in real-world settings, particularly in under-resourced regions. “Many people don’t even know they’re supposed to get tested,” he says. “There’s still a lot of stigma associated with liver disease, and poor access to healthcare in peripheral areas makes the problem worse.”
Over-the-counter medications and unregulated herbal supplements are another silent contributor to liver damage. The liver is responsible for metabolizing virtually everything we consume, including medicines, alcohol, and herbal tonics. Unfortunately, many people in India continue to self-medicate with drugs like paracetamol without understanding the cumulative damage these substances can cause to the liver. Herbal remedies, marketed as “natural” or “Ayurvedic,” are often consumed without scrutiny but can contain toxic compounds or contaminants harmful to liver health.
Dr. Radhika Venugopal, Senior Consultant in Hepatology and Liver Transplantation at Rela Hospital, Chennai, stresses the need to consider subtle symptoms seriously. “People often ignore signs like nausea, unexplained fatigue, or unexpected weight loss, thinking they’ll pass on their own. By the time more alarming symptoms like jaundice, fluid retention, or internal bleeding emerge, it’s usually too late for anything but aggressive intervention.”
She also points out that liver health assessments—such as liver function tests (LFTs), imaging scans, and FibroScan diagnostics—are not part of routine medical check-ups. Even when people seek healthcare for other issues, these screenings are seldom suggested unless the patient specifically complains of liver-related symptoms.
Pregnant women, individuals undergoing surgery, dialysis patients, and those diagnosed with HIV are supposed to be routinely screened for hepatitis as part of their standard care. But as Dr. Venugopal notes, “in practice, enforcement is sporadic at best.” Rural clinics are often understaffed, under-resourced, or simply not trained to prioritize hepatitis screening.
There’s another growing challenge—“lean MAFLD,” or metabolic-associated fatty liver disease in people who are not obese but have underlying metabolic issues like insulin resistance, high cholesterol, or hormonal imbalances. This condition is particularly dangerous because patients often consider themselves healthy due to their normal weight and fail to monitor their liver health. Early detection tools like FibroScan, which can detect liver fibrosis and fat buildup, are useful but not widely available outside of specialty centers.
Doctors are unanimous in their call for increased public awareness, routine check-ups, and lifestyle modifications. Vaccination against hepatitis B remains one of the most effective preventive measures available. Despite being included in India’s national immunization schedule, many adults remain unvaccinated. Additionally, physicians advise people to limit alcohol consumption, avoid self-medication, and consult healthcare providers regularly—especially if they fall into high-risk categories.
“The liver is a silent organ,” Dr. Shanmugam concludes. “It suffers in silence, and by the time it makes noise, the damage is usually done.” This haunting statement underlines the urgency of building robust screening infrastructure, particularly in public health systems and rural health networks.
In a country where health priorities often shift toward more visible or politically salient diseases, liver disease remains an overlooked epidemic, silently claiming lives and livelihoods. It’s time for that to change. A combination of policy support, clinical vigilance, public awareness, and preventive care could turn the tide before millions more slip through the cracks of a healthcare system not fully prepared to deal with this silent killer.
