Chronic Hepatitis B
Chronic hepatitis B is a long-term liver infection that can last for years or even a lifetime, raising the risk of serious liver damage, liver cancer, and death. While many people feel healthy and show no symptoms, the virus may still be active and causing harm that goes unnoticed for decades.
Table of contents
- What Is Chronic Hepatitis B
- Symptoms
- How It Spreads
- Possible Complications
- Diagnosis
- Treatment
- Regular Monitoring
- Staying Healthy with Chronic Hepatitis B
What Is Chronic Hepatitis B
Chronic hepatitis B describes a long-term infection with the hepatitis B virus (HBV) that has lasted more than six months[1][3]. When a person is first infected with HBV, this is called acute hepatitis B. For most adults, acute hepatitis B lasts less than six months and goes away on its own. However, if the body cannot clear the infection within six months, it becomes chronic and lifelong[1][2].
Chronic hepatitis B is usually identified by the presence of hepatitis B surface antigen (HBsAg) in the blood or serum for longer than six months[4]. Some people with chronic hepatitis B have an inactive form of the disease that does not cause significant health problems. However, others may develop progressive liver damage, including fibrosis (scarring of the liver), cirrhosis (severe scarring), and hepatocellular carcinoma (liver cancer)[4].
The chance of developing chronic hepatitis B depends heavily on age at infection. About 90% of infants infected at birth develop chronic infection, while only about 5% of adults who get acute hepatitis B go on to have chronic disease[8]. This is why newborns need to receive the hepatitis B vaccine right after birth[1].
The World Health Organization estimates that 254 million people worldwide were living with chronic hepatitis B in 2022[7]. In the United States, about 640,000 adults are estimated to have chronic hepatitis B[3][5]. About three out of four people with chronic hepatitis B in the United States are immigrants from regions of the world where the infection is common[6].
Symptoms
One of the most challenging aspects of chronic hepatitis B is that many people have no symptoms at all, especially in the early stages[1][3]. This is why hepatitis B is sometimes called a “silent killer”—even when you feel healthy, the virus may be active and causing liver damage[6][18]. Because of this, many people with chronic hepatitis B do not know they are infected[3].
When symptoms do occur, they may include[1][3][5]:
- Pain in the upper right part of the abdomen (stomach area)
- Dark-colored urine
- Light or clay-colored stool
- Fever
- Joint pain
- Loss of appetite
- Nausea and vomiting
- Weakness and extreme tiredness
- Jaundice, which is a yellowing of the skin and the whites of the eyes
Even though most people with chronic hepatitis B feel healthy and have no symptoms, the infection can still progress over time[6]. Symptoms often do not appear until much later in life, sometimes decades after the initial exposure, when significant liver damage has already occurred[3].
How It Spreads
Hepatitis B spreads when blood, semen, or certain other body fluids from a person infected with the virus enter the body of someone who is not infected[3]. The virus can be present even in microscopic amounts[3]. Body fluids that can transmit the virus include blood, semen, vaginal fluids, menstrual fluids, saliva, and amniotic fluid (fluid surrounding a baby during pregnancy)[5][7].
In areas where hepatitis B is very common, the virus is most often spread from mother to child during birth or delivery. This is called perinatal transmission[7]. The virus can also spread between young children during the first five years of life[7].
Other ways the virus can spread include[3][5][7]:
- Having unprotected sex with someone who has the virus
- Sharing needles, syringes, or other drug equipment with someone who has the virus
- Getting stuck with a contaminated medical instrument, such as a needle or scalpel
- Sharing personal items that may have come into contact with blood, such as razors or toothbrushes
- Tattooing or body piercing with contaminated equipment
You remain contagious as long as the virus is active in your body. If you have active chronic hepatitis B, you could be contagious for the rest of your life. However, if your chronic hepatitis B becomes inactive, the risk of spreading the virus would be lower[5].
Possible Complications
Without treatment, chronic hepatitis B can lead to serious and potentially life-threatening complications. The progression of liver disease is closely linked to the amount of HBV DNA (virus genetic material) in the blood[4].
Without antiviral treatment, about 8 to 20 out of every 100 people with chronic hepatitis B will develop cirrhosis within five years[4]. People with cirrhosis who remain untreated face a very serious risk—five-year survival rates can be as low as 15%[4].
The main complications of chronic hepatitis B include[1][5][6]:
- Cirrhosis: Severe scarring of the liver that builds up over time as the liver tries to repair damage caused by the virus
- Liver failure: When the liver becomes so damaged it can no longer work properly. This can happen suddenly (acute liver failure) or slowly over time (chronic liver failure)
- Liver cancer: Chronic hepatitis B is a leading cause of liver cancer. People with chronic hepatitis B have a similar or higher risk of developing cancer than someone who smokes one pack of cigarettes per day[6]
- Other health problems, including kidney disease, bone disease, diabetes, and heart disease[6]
Some people with chronic hepatitis B may also get infected with hepatitis D, another virus that only affects people who already have hepatitis B. If both infections are left untreated, up to 70% of affected people will develop cirrhosis[8].
Diagnosis
Diagnosis of chronic hepatitis B begins with a physical examination where a doctor looks for signs of liver damage, such as yellowing of the skin, stomach pain, or swelling[9][21].
Blood tests are the main way to diagnose hepatitis B. These tests can detect parts of the virus in your body and tell your doctor whether the infection is acute or chronic[1][5][9]. A simple blood test can also show if you are immune to the virus from vaccination or past infection[9].
Additional tests help doctors understand how much damage the virus has caused to your liver. These may include[9][21]:
- Blood tests that measure liver enzymes and other substances to check how well the liver is working
- Tests to measure viral load—the amount of virus genetic material in your blood
- Liver ultrasound or a special ultrasound called transient elastography that can show how much liver damage exists
- Liver biopsy—removal of a small sample of liver tissue for testing to check for damage or scarring
Many people should be tested for hepatitis B even if they feel healthy, because the virus often causes no symptoms[3]. All pregnant women should be tested at their first doctor visit for each pregnancy[9][19]. Other people who should get tested include those who were born in countries where hepatitis B is common, people who inject drugs, men who have sex with men, people living with or having sex with someone who has hepatitis B, and people with certain health conditions like HIV or kidney disease[9][19].
Treatment
There is no cure for chronic hepatitis B[5][15]. However, medications are available that can make the virus inactive, which means it cannot spread or cause further damage[5]. The main goal of treatment is to prevent the infection from progressing to cirrhosis, liver cancer, and liver failure[4].
Not everyone with chronic hepatitis B needs to take medication right away[10][11]. The decision to start treatment depends on several factors, including the amount of virus in your blood, your liver enzyme levels, the amount of liver damage, and your age[11][12]. Your doctor will help determine what is right for you.
There are two main types of medications for chronic hepatitis B[11]:
- Antiviral drugs: These are pills taken once a day that stop or slow down the virus from reproducing. This reduces inflammation and damage to your liver. Most people need to take these medications for at least one year, and often much longer or even for life[11].
- Interferon drugs: These are shots given over six months to one year that boost the immune system to help fight the virus[11].
While these medications can suppress the virus and prevent serious liver disease, they do not provide a complete cure. People who start treatment may need to take medication for the rest of their lives[10]. Sometimes medications can stop working or cause side effects, so it is important to see your doctor regularly for monitoring[6][18].
Treatment can reduce the risk of complications. Studies show that appropriate antiviral treatment can reduce the likelihood of developing liver cancer and other serious liver problems[4][12].
For people with acute hepatitis B, treatment is usually supportive care, which means rest, good nutrition, and plenty of fluids[10][20]. Most people with acute hepatitis B recover without specific medication.
Regular Monitoring
Living with chronic hepatitis B means you will need regular medical check-ups even if you feel healthy[6][18]. Getting tested regularly is an extremely important part of managing the condition. Your doctor should check your liver every six months to watch for signs of damage[6][16].
Important tests that your doctor may do include[6][18]:
- Hepatitis B DNA (viral load) test: This measures how much virus is in your body. If your viral load is above certain levels, your doctor may prescribe medicine. Your viral load should be as close to undetectable as possible. Being undetectable does not mean you are cured, but it means the amount of virus is so low it cannot be measured by lab tests.
- ALT (alanine aminotransferase) test: ALT is an enzyme found in liver cells. When the liver is damaged, ALT can leak into the bloodstream. High ALT levels may indicate active liver damage.
- Liver cancer screening: This may include an AFP (alpha-fetoprotein) blood test and liver ultrasound to screen for cancer. Screening is especially important because people with chronic hepatitis B are at increased risk for liver cancer.
Even if your test results are normal, they can change over time. That is why seeing your doctor regularly is so important—it helps monitor the virus and allows treatment to start if needed[6][18].
Research shows that people with chronic hepatitis B who have regular screening live much longer. One study found that more than one-third of people with the infection lived much longer if they had six-monthly screening compared to no screening at all[22].
Staying Healthy with Chronic Hepatitis B
If you have chronic hepatitis B, there are many things you can do to protect your liver and improve your overall health[16][17]:
- Schedule regular visits with a liver specialist or healthcare provider who has expertise in managing hepatitis B
- Get vaccinated against hepatitis A to protect yourself from another virus that attacks the liver[16]
- Avoid drinking alcohol completely—any amount of alcohol can harm your liver[16][17]
- Do not smoke, as smoking is harmful to your liver
- Eat a healthy diet with plenty of fruits, vegetables, whole grains, and lean protein[16]
- Exercise regularly[10]
- Talk to your doctor before taking any herbal remedies, vitamin supplements, or over-the-counter medications, as some can damage your liver or interfere with your hepatitis B medications[16][17]
- Avoid breathing in fumes from paint, cleaning products, and other chemicals that could harm your liver[16]
It is also important to protect others from infection. Make sure your close family members, household contacts, and sexual partners get tested for hepatitis B and receive the vaccine if they are not immune[16].
People living with chronic hepatitis B can expect to live long and healthy lives, especially with proper medical care and healthy lifestyle choices[11][16]. The key is to stay on top of your health by seeing your doctor regularly, getting tested, and taking steps to protect your liver.
