Chronic hepatitis B virus hepatitis

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)

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:

1. NICE. Hepatitis B (chronic): diagnosis and management. Clinical guideline CG165. Published June 2013, last updated: 20 October 2017
2. World Gastroenterology Organization (WGO) 2015. World Gastroenterology Organisation Practice Guideline. Hepatitis B