An Overview of Hepatitis B

Men are at greater risk for the disease

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Hepatitis B is an inflammation of the liver caused by a virus. Globally, there are over 400 million chronic carriers of hepatitis B. Of the 200,000 people who contract hepatitis B each year in the U.S., 10 to 15,000 go on to develop a chronic form of the disease. Men are six times more likely than women to become chronic carriers of the hepatitis B virus (HBV), but the reasons for this are unclear.

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Types of Hepatitis B

Of the adults who get the Hepatitis B virus, 95% clear the virus and do not go on to have the chronic form of the disease. Some people have few symptoms or none at all, so many do not realize they have HBV or that they have had it.

Many adults will clear the virus completely within six months. The good news is that the protective antibodies produced while fighting the infection mean that people who have had it will never have to worry about HBV again—they will be immune.

There are three types of hepatitis B infections:

  1. Healthy chronic carriers of hepatitis B are not infectious to others and, although they may have a slightly higher risk of cirrhosis and liver cancer than the general population, they mostly live normal lives. The virus can become reactivated if their immune systems become suppressed, such as during a severe illness, during treatment with immunosuppressant drugs for diseases like cancer or AIDS, or with drugs such as steroids.
  2. Chronic infectious hepatitis B is highly infectious. The person with it may have a very inflamed and damaged liver even when the person has few or no symptoms. People with this type of hepatitis B are more likely to have a progressive disease leading to cirrhosis. Only 5% to 10% have spontaneous remission, become noninfectious to others, and sustain no further or minimal liver damage, although sometimes reactivation of the virus occurs.
  3. Chronic mutant hepatitis B is a mutated strain of the virus with a permanent alteration of the hepatitis B virus’s genetic makeup. Those with it have the potential to be infectious to others and it is thought to be more resistant to treatment than other forms of the disease.


Hepatitis B is transmitted through contaminated bodily fluids like:

  • Blood
  • Sweat
  • Tears
  • Saliva
  • Semen
  • Vaginal secretions
  • Menstrual blood
  • Breast milk

Transmission can also occur when using the same syringe as an infected person, like receiving blood transfusions prior to 1975 (blood supplies are now screened in most countries) and getting tattoos or body piercings.

Hepatitis B can also be transmitted during childbirth from mother to child, during medical procedures, through occupational exposure, and during sexual intercourse. Having Hepatitis B does not necessarily mean that a person is infectious to other people—only some people with HBV are contagious.

Signs and Symptoms

There are many ways people may discover they have hepatitis. Because there are sometimes so few specific symptoms beyond fatigue, for example, that it may only be diagnosed when blood tests are performed—sometimes for unrelated reasons, such as prior to giving blood donations, for insurance purposes, for general health checks, or when following work-related injuries.

Acute Hepatitis B

In its severe form, hepatitis B symptoms can make the person feel extremely ill. Others may believe they have the flu while some may experience no symptoms at all.

Symptoms include jaundice, fever, abdominal pain, poor appetite, nausea, vomiting, fatigue, dark colored urine, light-colored stools, muscle and joint pain, and rash. The liver may also be enlarged and tender.

Fulminant hepatitis is a severe but very rare form of acute hepatitis. It may begin with fatigue and nausea, but, within a few weeks, the signs and symptoms become pronounced. About two weeks after jaundice develops, encephalopathy develops. 

Encephalopathy is a state of impaired or altered mental status resulting from the inability of the damaged liver to remove toxins from the blood. In its mild form, there may be some short-term memory loss, forgetfulness, slurring of speech, small behavioral personality or behavioral changes, or changes in sleep patterns.

In its severe form, a person may experience severe loss of memory (not knowing the date, the year, their own name or address), confusion, exhibit inappropriate behavior, poor coordination, asterixis (uncontrollable flapping of the hands), fetor hepaticus (foul-smelling breath), and coma. Up to 85% of people with this type of rare hepatitis will die without a liver transplant.

Chronic Hepatitis B

Again, signs and symptoms can vary and many people will be unaware that anything profound is wrong or experience only vague symptoms. These can include mild or restless fatigue, jaundice, and an enlarged liver. Unfortunately, if chronic hepatitis is not cleared by the body or is not successfully treated and cured, liver disease or liver failure may result.

Diagnostic Blood Tests

Blood tests will show the presence of the disease and what is affected. A hepatitis B serology blood test will give an accurate diagnosis of the type of hepatitis present as there are different strains of the virus.

Liver Function 

These blood tests show how well the liver is functioning but does not accurately assess all of the many and varied functions that the liver is responsible for in our bodies. They do check the level of liver enzymes, transaminases and cholestatic enzymes, bilirubin, and liver protein levels—all of which can be affected by the liver virus.

High levels of transaminases in the blood do not always reveal how badly the liver is inflamed or damaged. Elevations in these can also occur as a result of genetic liver disease, liver tumors, and heart failure. The normal ranges of AST and ALT transaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively. In chronic hepatitis B, the levels are usually two to three times above the normal range.

Liver Proteins

Albumin, prothrombin, and immunoglobulins—proteins made by the liver—are checked and abnormal levels are indicative of the severe liver disorder. Prothrombin times need to be determined, too, because the liver produces many of the clotting factors required to stop bleeding.

Liver Biopsy

Liver biopsy is one of the main and most accurate diagnostic procedures that can determine what is wrong with the liver and how badly it has been damaged. As most liver diseases affect the entire organ uniformly, the small sample obtained by biopsy, generally performed under a local anesthetic, will show any abnormalities. For most, the guided liver biopsy is a safe and efficient diagnostic tool.


The FDA (Food and Drug Administration) has approved two drug types, alpha-interferon, and lamivudine. Alpha interferon, given by injection, stimulates the body’s immune system and is administered for 16 weeks. It is very expensive and does have a number of side effects, a few of them serious. Lamivudine is taken orally for 52 weeks, and although it has few side effects, it is not as long-lasting as interferon. Relapse is a common feature and its use can lead to antiviral resistance.

Response rates to the drugs in successful treatment programs are variable. In 2002, the FDA reported that it is "above 50% in patients with ALT levels greater than five times the upper normal limit of normal, but lower (20% to 35%) in patients with ALT levels less than two times the upper limit of normal. In patients with ALT levels less than two times the upper limit of normal, response rates are poor and therapy should be deferred."

A new drug type—nucleotide analog adefovir dipivoxil (Hepsera)—offers a potential third option and was approved by the FDA for the treatment of hepatitis B in September 2002. There are now several antivirals that have been approved by the FDA.

Acute Hepatitis B

Acute hepatitis B is treated conservatively with rest and plenty of fluids. You may not need bed rest; it depends on how ill you feel.

If you are up to it, then there is no reason why you should not go to work. It is important to lead a healthy life, so stop smoking (try hard!) and eat a healthy diet. Definitely give up alcohol for a few months as the liver needs time to recover.

Chronic Hepatitis B

For those people whose bodies are unable to clear the virus, HBV will go on to become a chronic condition. Not long ago there was no treatment for hepatitis B; however, there are now a number of treatments available that are proving very effective.

The future is looking a lot brighter and scientists and drug companies are hoping that, within the next few years, a treatment will be discovered that will offer a cure for everyone with chronic hepatitis B.

Treatment with antiviral therapy is available for people with chronic hepatitis B although it is not recommended for all infected individuals. Treatment is aimed at the suppression of the hepatitis B virus and stopping the active liver disease. 


  • Approximately 2% of people with chronic hepatitis B go on to develop cirrhosis each year.
  • Over five years, the cumulative probability of developing cirrhosis is 15% to 20%.
  • The five-year survival rate after cirrhosis develops is between 52% and 80%.
  • If decompensated cirrhosis (cirrhosis accompanied by complications such as bleeding and encephalopathy) develops, survival rates decrease to between 14% and 32%.
  • With an increased risk of liver cancer, about one million people worldwide die yearly from the complications of hepatitis B.

Prognosis is less favorable for those with the following factors:

  • Poor general health
  • Access to inadequate health systems, lack of funds, poor hygiene, etc.
  • Advanced age
  • Infections of hepatitis D and hepatitis B together
  • Infections of hepatitis C and hepatitis B together
  • Advanced hepatitis
  • Continued consumption of alcohol after a diagnosis of chronic hepatitis

Note: Hepatitis D (HDV) can only exist with the hepatitis B virus. Hepatitis D is transmitted in the same way as hepatitis B and can be caught at the same time as HBV (co-infection) or subsequent to HBV infection. Co-infection is known to clear the body well (90% to 95%). In the case of superinfection, 70% to 95% go on to have the more serious chronic form of HDV.


A vaccine is available and is advised for those at risk or in contact with the disease. The vaccine is 80% to 100% effective in preventing hepatitis B and the chronic form of the disease.

Seventy-nine percent of World Health Organization members have adopted the universal childhood hepatitis B vaccination policy. Unfortunately, the cost of the vaccination and the simple means of transmission of this virus mean that the overall incidence of hepatitis B infections continues to rise.

People who know they are infected carriers of the hepatitis B virus can take precautions to prevent infecting others. These include the appropriate disposal of contaminated waste, using separate toothbrushes and scissors, never sharing needles and syringes with others, always using condoms, and avoiding anal intercourse.

If your job involves working in high-risk areas, you should consult your healthcare provider for advice on precautions and any effects that it may have on your future health. All people infected with hepatitis B should get a hepatitis A vaccine to prevent potential infection.


If you find out you have hepatitis B, don't despair. Get a healthcare provider specializing in hepatology to advise you on the best treatments and on how you can maximize your health to fight the virus.

Remember, you are not alone. There are millions of people with hepatitis B. Find a local support group through the internet or ask your medical team that is providing your care what support systems are available to you.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Rajbhandari R, Chung RT. Treatment of hepatitis B: A concise reviewClin Transl Gastroenterol. 2016;7(9):e190. doi:10.1038/ctg.2016.46

  2. Centers for Disease Control and Prevention. Hepatitis B questions and answers for the public.

  3. Ferenci P. Hepatic encephalopathyGastroenterol Rep (Oxf). 2017;5(2):138-147. doi:10.1093/gastro/gox013

  4. Rizzetto M. Hepatitis D Virus: Introduction and epidemiologyCold Spring Harb Perspect Med. 2015;5(7):a021576. doi:10.1101/cshperspect.a021576

  5. Centers for Disease Control and Prevention. Hepatitis B.

By Jerry Kennard
 Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.