Chronic hepatitis B occurs when the body cannot eliminate the hepatitis B virus following an acute infection. Having chronic (or lifelong) hepatitis B can increase a person’s risk of developing advanced liver disease, such as cirrhosis.

Diagnosing chronic hepatitis B can require specialized tests. Typically, doctors consider hepatitis B to be chronic when a person tests positive for the hepatitis B virus for more than 6 months after their first positive blood test.

While there is no cure for chronic hepatitis B, medications and other interventions are available to help keep the amount of virus in the body low and prevent further damage to the liver.

Read on to learn more about chronic hepatitis B, including symptoms, causes, and how doctors treat it.

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Many people with chronic hepatitis B do not experience lots of symptoms. If symptoms do appear, they can include:

  • low-grade fever
  • tiredness
  • loss of appetite
  • generally being unwell
  • discomfort in the upper abdomen

For those with chronic hepatitis B, new or worsening symptoms may be a sign of advanced liver disease. About 15– 25% of chronic hepatitis B infections can lead to liver damage, cirrhosis, and liver cancer.

As liver function deteriorates, people with cirrhosis can have symptoms including:

  • easy bruising and bleeding
  • swelling of legs, ankles, and feet
  • fluid accumulation (ascites) in the abdomen
  • dark-colored urine
  • jaundice, or yellowing of skin and eyes
  • confusion

People experiencing new or worsening symptoms should seek help from a healthcare professional.

Hepatitis B spreads when blood, semen, or other bodily fluids containing the virus enters the body of a person who is not infected or is unvaccinated.

People can contract the hepatitis B virus through:

  • birth (spread from a mother with hepatitis B to their newborn)
  • sex with a partner who has hepatitis B
  • sharing needles or syringes
  • sharing a toothbrush or razor with someone with hepatitis B
  • direct contact with open sores, wounds, or the blood of someone with hepatitis B
  • accidental contact with blood from someone who has the hepatitis B infection via sharp medical instruments

Doctors consider hepatitis B to be chronic when a person tests positive for the virus for more than six months after their first positive blood test.

Learn more about the risk factors for hepatitis B here.

How does it become chronic?

Chronic hepatitis B generally indicates that the immune system cannot completely eradicate the virus, so it remains in the blood and liver.

A person’s age at initial infection can play a role in whether hepatitis B will become chronic. The younger a person is when the virus infects them, the greater their risk of developing a chronic infection.

Around 9 in 10 infected infants later develop chronic hepatitis B, but the risk decreases inversely to age.

Up to half of infected children between 1 and 5 years old develop chronic hepatitis B. Most older children and adults who contract the hepatitis B virus will recover and experience no long-term symptoms. However, around 5–10% of infected adults will develop a chronic infection.

Doctors may suspect that a person has a chronic hepatitis B infection if:

  • they already have a diagnosis of acute hepatitis B
  • they experience symptoms
  • routine blood tests reveal that liver enzymes, such as aminotransferase, are high

Confirming a diagnosis of chronic hepatitis B requires specialized tests. These typically involve:

  • detecting hepatitis B surface antigen (HBsAg) in the blood
  • measuring the viral load, which is the amount of virus present in the blood
  • measuring antibody responses to the virus — for example, the response of the hepatitis B core antibody (anti-HBc)

A liver biopsy may help determine the extent of damage to the liver.

Doctors treat chronic hepatitis B using antiviral medications that target the virus. Oral medications include:

  • tenofovir alafenamide (Vemlidy)
  • tenofovir disoproxil fumarate (Viread)
  • entecavir (Baraclude)

Not everyone with hepatitis B requires medication. Some people may need to take medication intermittently. Treatment for those at greater risk of developing liver complications is typically advisable.

Treating complications

Seeking help from a liver specialist is beneficial when chronic hepatitis B has led to cirrhosis. They will be able to perform further tests and provide advice on the best treatment course.

Treatment can include medications and medical procedures. A liver transplant may be necessary in cases of liver failure.

Additional steps that people with hepatitis B can take to improve their outlook include:

  • seeking medical help when they receive a diagnosis
  • getting vaccinated against hepatitis A and hepatitis B
  • avoiding drinking alcohol
  • maintaining a healthy and balanced diet
  • checking with a doctor or other health professional before taking any new medications because some can cause liver problems

Learn more about the hepatitis B vaccine here.

There is no cure for hepatitis B, although there are effective treatments that can suppress virus production and reduce liver damage.

Once the acute phase of infection develops into chronic hepatitis B, it is typically a lifelong condition. However, viral suppression means that the virus becomes undetectable and the risk of spreading it gets lower.

Chronic hepatitis B is typically a lifelong condition. The chance that an acute infection will progress to a chronic one is highest in infancy — around 9 in 10 infants who have the hepatitis B virus go on to develop a chronic infection.

Not everyone with the condition will develop symptoms, but these may appear as liver function deteriorates. If a person develops cirrhosis, they may experience abdominal swelling, jaundice, and other serious symptoms.

Doctors can use specialized tests to confirm a diagnosis of chronic hepatitis B, including detecting HBsAg. While there is no cure, people with chronic hepatitis B often have long symptom-free periods. The treatment course may involve antiviral medications and making certain lifestyle changes.