chronic hepatitis B virus hepatitis
Last edited 06/2018 and last reviewed 03/2022
Chronic hepatitis B is defined as persistence of hepatitis B surface antigen (HBsAg) for 6 months or more after acute infection
- 2-10% of immunocompetent adults fail to clear HBsAg from the blood and develop chronic infection.
The risk of chronic infection with hepatitis B virus depends on the nature of the immune response to the initial infection. This varies according to the age at which the infection is acquired (2)
outcome |
neonates |
children |
adults |
chronic infection |
90% |
30% |
1-5% |
recover |
10% |
70% |
95-99% |
In some people, chronic hepatitis B is inactive and does not present significant health problems, but others may progress to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC)
- progression of liver disease is associated with hepatitis B virus (HBV) DNA levels in the blood
- without antiviral treatment, the 5-year cumulative incidence of cirrhosis ranges from 8 to 20%. People with cirrhosis face a significant risk of decompensated liver disease if they remain untreated
- five-year survival rates among people with untreated decompensated cirrhosis can be as low as 15%
Chronic hepatitis B can be divided into e antigen- (HBeAg) positive or HBeAg negative disease based on the presence or absence of e antigen. The presence of HBeAg is typically associated with higher rates of viral replication and therefore increased infectivity
Reference:
natural history of chronic hepatitis B virus infection
treatment of chronic hepatitis B hepatitis
assessment of hepatitis B and referral criteria from primary care
phases of hepatitis B infection - relating HBe antigen, HBV DNA levels and antibody to HBe antigen
host and viral risk factors associated with progression of chronic hepatitis B
NICE guidance on management of chronic hepatitis B infection