prognosis

Last reviewed 01/2018

Exposure to HBV can produce a variety of different states (the percentages quoted are for adults):

  • 60-65% show subclinical disease and recover fully i.e. no resultant liver damage
  • 20-25% develop acute hepatitis:
    • 99% of patients recover
    • 1% develop fulminant hepatitis - with a case mortality of about 80%
  • 5-10% become "healthy" carriers i.e. HBsAg +ve after 6 months - less than 5% show changes on liver biopsy that range from non-specific minimal abnormalities to chronic active hepatitis and cirrhosis. Infectivity and ongoing disease is indicated by a positive serum HBV DNA, IgM anti-HBc and HBeAg
  • 5-10% develop chronic hepatitis - which may be:
    • chronic persistent
    • chronic active - which may progress to cirrhosis and hepatocellular carcinoma

The likelihood of chronic disease following HBV exposure is more likely in:

  • males than females - a 6 fold increased risk
  • in those with immunological incompetence, such as:
    • the very young and the very old - more than 90% of exposed neonates develop chronic disease
    • homosexuals
    • AIDS sufferers
    • patients with underlying malignancy e.g. leukaemia
    • patients on immunosuppressive therapy

The risk of hepatocellular carcinoma is increased 10-390 fold in patients with chronic HBV disease.

Concomitant infection with hepatitis D virus is generally associated with a poorer prognosis than infection with HBV alone.

Reference:

  1. Pulse 2002; 62(31):8.
  2. Prescriber 2005; 16(6):66-75.
  3. Wright, TL et al.. Clinical aspects of hepatitis B virus infection. Lancet 1993; 342: 1340-45.