Chronic hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that has lasted more than 6 months.
Most people with chronic hepatitis B have no symptoms, but some feel generally ill and tired and lose their appetite.
Doctors diagnose hepatitis B based on blood tests and occasionally do a liver biopsy to determine how damaged the liver is.
Not everyone with chronic hepatitis B needs treatment, but if chronic hepatitis B is damaging the liver (causing inflammation or scarring), an antiviral medication is started.
Treatment with antiviral medications can help suppress the virus, prevent further inflammation and scarring in the liver, and allow any already damaged areas to heal. However there is no cure.
Having chronic hepatitis B increases the risk of liver cancer.
(See also Overview of Hepatitis, Overview of Chronic Hepatitis, and Hepatitis B, Acute.)
An estimated 862,000 people in the United States and about 257 million people worldwide have chronic hepatitis B.
Overall, about 5 to 10% of people with acute hepatitis B develop chronic hepatitis B. The younger the person is when acute hepatitis B occurs, the higher the risk of developing chronic hepatitis B:
Infants: 90%
Children aged 1 to 5 years: 25 to 50%
Adults: About 5%
If the level of hepatitis B virus (viral load) is high in pregnant women, they are often given antiviral medications during the last trimester of pregnancy to prevent transmission of the virus from mother to child.
Acute hepatitis B becomes chronic in about 40% of people being treated with hemodialysis and in up to 20% of people with a weakened immune system.
Chronic hepatitis B tends to worsen, sometimes rapidly but sometimes over decades, leading to cirrhosis. Chronic hepatitis B also increases the risk of liver cancer. About 20% of people with chronic hepatitis B develop cirrhosis or liver cancer and may die prematurely.
Some people who have chronic hepatitis B also have chronic hepatitis D. If untreated, the combination causes cirrhosis in up to 70% of affected people.
Symptoms of Chronic Hepatitis B
Symptoms of chronic hepatitis B vary depending on how badly the liver is damaged.
Many people with chronic hepatitis B, particularly children, have no symptoms. People who have symptoms usually feel generally ill and tired and lose their appetite. Some people have a low-grade fever and vague discomfort in the upper abdomen.
Often, the first specific symptoms occur when the liver disease has progressed and there is evidence of cirrhosis. Symptoms can include
An enlarged spleen
Small spiderlike blood vessels visible in the skin (called spider angiomas)
Redness of the palms
Accumulation of fluid within the abdomen (ascites)
A tendency to bleed (coagulopathy)
Bleeding in the digestive tract due to esophageal varices
Jaundice (yellowing of the skin and whites of the eyes)
Deterioration of brain function due to malfunction of the liver (hepatic encephalopathy)
Brain function deteriorates because toxic substances build up in the blood and reach the brain. The liver normally removes them from the blood, breaks them down, then excretes them as harmless by-products into the bile or blood. The badly damaged liver is less able to remove them.
People have a tendency to bleed because the damaged liver can no longer synthesize enough of the proteins that help blood clot.
Diagnosis of Chronic Hepatitis B
Blood tests
Doctors may suspect chronic hepatitis B when
People have typical symptoms.
Blood tests (done for other reasons) detect abnormally high liver enzymes.
People have previously been diagnosed with acute hepatitis B.
Testing for chronic hepatitis usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver tests). Liver tests involve measuring the levels of liver enzymes and other substances produced by the liver. These tests may help determine the severity of liver damage.
If tests suggest hepatitis, doctors do other blood tests to check for the hepatitis B and C viruses. Both can cause chronic hepatitis. These blood tests can identify parts of specific viruses (antigens), specific antibodies produced by the body to fight the virus, and sometimes genetic material (RNA or DNA) of the virus. If doctors strongly suspect only hepatitis B, they may do blood tests for only that virus.
Doctors do blood tests to measure viral load, which is the amount of the hepatitis B virus's genetic material (DNA) that is present.
If chronic hepatitis B is confirmed, doctors often also check for antibodies to hepatitis D, which can also be present, and for HIV infection and hepatitis C because these infections are often spread in the same ways (through contact with bodily fluids, such as blood or semen).
A liver biopsy or other tests are occasionally done to determine how badly the liver is damaged.
Screening for liver cancer
If people have chronic hepatitis B, screening for liver cancer is done:
Ultrasound studies every 6 months
Sometimes blood tests to measure the level of alpha-fetoprotein
The level of alpha-fetoprotein—a protein normally produced by immature liver cells in fetuses—usually increases when liver cancer is present.
Treatment of Chronic Hepatitis B
Antiviral medications
Sometimes liver transplantation
Antiviral medications are used when people have one or a combination of the following:
Abnormally high levels of liver enzymes
A high viral load (the amount of hepatitis B virus DNA in the blood)
Symptoms of worsening disease
Biopsy results indicating that liver damage is continuing
Treatment of hepatitis B with antiviral medications can prevent further damage to the liver and allow any already damaged areas to heal. Most people treated for chronic hepatitis B must be treated indefinitely. However, these medications cannot cure the disease.
Stopping treatment prematurely can lead to relapse, which may be severe. However, treatment may be stopped if blood tests no longer detect any active hepatitis B virus infection.
One of the following antiviral medications is usually used first:
Tenofovir
Pegylated interferon-alfa
These medications are taken by mouth, are very effective, and have few side effects. Some people may be able to stop taking these medications, but many have to take them indefinitely.
Liver transplantation should be considered if liver function is severely impaired. The transplanted liver is more likely to survive and hepatitis B is less likely to recur if
People with chronic hepatitis B have been taking antiviral medications for a long time.
They are treated with hepatitis immune globulin before and often after transplantation.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Centers for Disease Control and Prevention: Hepatitis B: This website provides links to an overview of hepatitis B (including definitions, statistics, transmission, and screening) and information about the hepatitis B vaccine, symptoms, diagnosis, and treatment, as well as links to information for health care practitioners. Accessed May 10, 2024.
