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Acute vs. Chronic HBV

Acute Hepatitis B - Recovery - Chronic Hepatitis B

Acute Hepatitis B

An acute infection may last up to six months (with or without symptoms) and infected persons are able to pass the virus to others during this stage. A patient will test positive for the hepatitis B virus (HBsAg+), HBc-IgM, and possibly the HBe-antigen. Safe sex practices and vaccination of close household members should be recommended.

Symptoms of an acute infection may include loss of appetite, myalgia, nausea, low-grade fever, and possible right upper quadrant or midepigastric pain. Although most people do not experience symptoms, they can appear 45 to 180 days after the virus enters the body. Some people may experience more severe symptoms that will require immediate medical attention. 

A small number of people have symptoms that last for months. They may have signs of abnormal liver function before they completely recover from the acute infection. Most infected persons do not require hospitalization, although some may require close medical attention.

Treatment of acute hepatitis B is generally supportive, which may or may not require hospitalization. Rest and managing symptoms are the primary goals of therapy. Additional follow-up blood tests are needed to diagnose recovery  from an acute infection or the progression to a chronic infection.

In rare cases involving fulminant hepatitis, liver transplantation may be indicated.

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An estimated 90% of adults with healthy immune systems will recover successfully from an acute infection and develop positive surface antibodies that will protect them against future hepatitis B infections.

Infants and children, however, have a much higher risk of progressing to a chronic infection when first infected with hepatitis B. Infants have only a 10% of recovering from an acute infection and young children have up to a 50% chance of recovering. Therefore, the age at which one is first infected makes a significant difference in determining the final outcome.

When blood tests show that a person has lost the virus (HBsAg-) and develops the protective surface antibody (HBsAb+ or anti-HBs+), then they have recovered from an acute infection and are no longer contagious to others. This can take up to six months after the initial infection.

People who have recovered are still at risk for other types of hepatitis infections. Therefore, people who have recovered should get the hepatitis A vaccine and avoid risk factors for hepatitis C. In addition, this group should be advised to limit their alcohol, quit smoking, and avoid liver toxins to avoid future liver disease problems. Follow-up visits may be recommended.

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Chronic Hepatitis B

If a person tests positive for the hepatitis B virus (HBsAg+) for more than 6 months, then they are diagnosed as having a chronic infection. Approximately 10% of infected adults will develop chronic infections, which increases their risk for cirrhosis, liver failure or liver cancer.

The risk of developing a chronic hepatitis B infection is directly related to the age at which one becomes infected with the virus. 90% of infants infected at birth and up to 50% of young children infected between the ages of 1 and 5 years will develop a chronic hepatitis B infection.

Most people with chronic infection have no symptoms, but they can still spread the virus to others. Therefore, screening and vaccination of close family or household members and sex partners should be initiated to prevent further infection.

All patients with chronic hepatitis B infections should be monitored on a regular basis for disease progression by a liver specialist ("hepatologist") or a doctor knowledgeable about hepatitis B.

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Page last modified October 21, 2009