4. What is the natural history and progression of hepatitis B?

A little bit about the natural history of hepatitis B. There is the acute infection, if you’re a newborn child (born to a mother with hepatitis B) and you do not receive the hepatitis B immune globulin, or the vaccine as a young baby, there is a 90% or more chance of infection. However, probably less than 10% of adults develop chronic infection, so most adults will recover from acute hepatitis B. When it’s chronic, the concerns are over time, liver cancer and over time, cirrhosis. Now there are two kinds of cirrhosis, there is cirrhosis in which the individual has good liver function and really feels OK, can work full-time, can run a marathon, really has good liver function. And then there’s cirrhosis with liver failure or decompensation, and that in one study occurred in about a quarter over a five year period. Now if there is liver cancer, or liver failure, that may eventually lead to death. But as shown in the center here, we now are able to apply, not to everybody as we would like, but to some segment of the population, are candidates if they have a small tumor, for liver transplantation or with liver failure, can also undergo transplantation. Chronic hepatitis B is the 6th leading cause of liver transplantation in the US, so it’s not the top cause, hepatitis C and alcohol are the top causes, but it’s up there in terms of top causes for liver transplant.