Acute vs. Chronic Hepatitis B
A hepatitis B infection can result in either an acute infection or a chronic infection. When a person is first infected with the hepatitis B virus, it is called an "acute infection" (or a new infection). Most healthy adults that are infected do not have any symptoms and are able to get rid of the virus without any problems. Some adults are unable to get rid of the virus after six months and they are diagnosed as having a "chronic infection." A simple blood test can diagnose an acute or chronic hepatitis B infection.
The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection:
- More than 90% of infants that are infected will develop a chronic hepatitis B infection
- Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection
- 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection (that is, 90% will recover from an exposure)
Most pregnant women do not know whether they are infected with hepatitis B and can unknowingly pass the virus to their newborns during childbirth. Therefore, since the risk of newborns becoming chronically infected at birth is so high, both the World Health Organization and the U.S. Centers for Disease Control and Prevention recommend that all infants receive the first dose of the hepatitis B vaccine within 12-24 hours after birth.
The recommendation for hepatitis B vaccination of babies and children is so important because they are at the greatest risk of developing a chronic infection if they are not protected against the hepatitis B virus as soon as possible.
An acute hepatitis B infection may last up to six months (with or without symptoms) and infected persons are able to pass the virus to others during this time. A simple blood test can let a person know if the hepatitis B virus is in their blood or if they have successfully gotten rid of the virus. The doctor should periodically test your blood over the six-month period to monitor the health of your liver and check progress towards recovery. In a person who has recovered from an acute hepatitis B infection, a blood test taken six-months after initial diagnosis will show that there is no more hepatitis B virus in your blood.
Being diagnosed with acute hepatitis B can be difficult. As you move through the initial six-month period, there are tips and strategies to help.
Until your health care provider confirms that the blood test shows that there is no more hepatitis B virus in your blood, it is important to protect others from a possible infection.
It is also important to have your sexual partner(s) and family members (or those you live in close household contact) get tested for hepatitis B. If they have not been infected – and have not received the hepatitis B vaccine – then they should also start the hepatitis B vaccine series.
Symptoms of an acute infection may include loss of appetite, joint and muscle pain, low-grade fever, and possible stomach pain. Although most people do not experience symptoms, they can appear 60-150 days after infection, with the average being 90 days or 3 months. Some people may experience more severe symptoms such as nausea, vomiting, jaundice (yellowing of the eyes and skin), or a bloated stomach that may cause them to see a health care provider.
If treatment for an acute hepatitis B infection is required, a person may be hospitalized for general support. Rest and managing symptoms are the primary goals of this medical care. A rare, life-threatening condition called “fulminant hepatitis” can occur with a new acute infection and requires immediate, urgent medical attention since a person can go into sudden liver failure.
Simple tips for taking care of your liver during a new infection is to avoid alcohol, stop or limit smoking, eat healthy foods, avoid greasy or fatty foods, and talk to your health care provider about your prescriptions, over-the-counter medications and ask any other questions you may have during this time. The use of vitamins and liver health supplements will likely not assist your recovery and may actually cause more harm than good to the liver.
Be sure to follow-up with your health care provider for any additional blood tests that are needed to confirm your recovery from an acute infection.
Acute hepatitis B infections have few, if any, lasting effects. However, recovery from an acute infection means that while the virus is no longer in your blood, it is still living in the liver in an inactive state. You cannot infect anyone else, and you are not considered to be infected. However, the virus that is in your liver can be re-activated in the future if you take medications that suppress the immune system. This can be dangerous for the liver. Therefore, it is important that you tell all of your health care providers that you had a past hepatitis B infection. This way, if you need immune-suppressing medication, your provider can take precautions to prevent the hepatitis B virus from re-activating. This simple fact sheet can help you better understand this. You can print this fact sheet and bring it to your health care provider’s office.
People who test positive for the hepatitis B virus for more than six months (after their first blood test result) are diagnosed as having a chronic infection. This means their immune system was not able to get rid of the hepatitis B virus and it still remains in their blood and liver.
The risk of developing a chronic hepatitis B infection is also directly related to the age at which one first becomes exposed to the hepatitis B virus:
- 90% of infected newborns and babies will develop a chronic hepatitis B infection
- Up to 50% of infected children (1-5 years) will develop a chronic hepatitis B infection
- 5-10% of infected adults will develop a chronic hepatitis B infection (that is, 90% will recover)
Learning that you have a chronic hepatitis B infection can be very upsetting. Because most people do not have symptoms and can be diagnosed decades after their initial exposure to the hepatitis B virus, it can be a shock and a surprise to be diagnosed with a chronic hepatitis B infection. The good news is that most people with chronic hepatitis B should expect to live a long and healthy life.
There are effective drug therapies that can control and even stop the hepatitis B virus from further damaging a liver. There are also promising new drugs in the research pipeline that could provide a cure in the very near future. Although the risk of developing a serious liver disease or liver cancer is higher for those living with chronic hepatitis B than those who are not infected, there are still many simple things a person can do to help reduce their risks.
- Schedule regular visits every six months (or at least every year) with a liver specialist or a health care provider who is knowledgeable about hepatitis B so they can monitor the health of your liver through blood tests or diagnostic imaging
- Talk to your health care provider about whether treatment for your chronic hepatitis B infection would be helpful in preventing serious liver disease or liver cancer. It is important to understand that not everyone is a candidate for treatment, but everyone with chronic HBV benefits from regular monitoring
- Make sure that your health care provider screens you for liver cancer during your regular visits since early detection equals more treatment options and a longer life
- Avoid or limit alcohol and smoking since both cause a lot of stress to your liver
- Eat a healthy diet with lots of vegetables since fried, greasy foods are hard on your liver
To learn more about other ways to protect your liver and your health click here.