As with all viral infections, the severity of symptoms can vary widely, from none to very severe symptoms. Most people with hepatitis B will have some periods in their lives when they are free of symptoms, while others may not develop symptoms for decades or even their whole lifetime. Unfortunately, other people can experience severe hepatitis B symptoms.

The 2 forms of illness related to hepatitis B infection are acute hepatitis B and chronic hepatitis B.

Acute hepatitis B

In the acute, short-term, form of hepatitis B, very severe inflammation of the liver occurs. People with acute hepatitis become very fatigued and may develop jaundice, in which the whites of the eyes or the roof of the mouth become noticeably yellow. As hepatitis can be caused by many things besides hepatitis B virus, the doctor needs to do special viral tests to determine the cause. Acute hepatitis B can also cause fever, loss of appetite, loss of taste for cigarettes, and pain in the lower right chest or upper right abdomen. There is often a feeling of bloating in the abdomen, and bowel habits may change. The urine may appear dark or cola-coloured, and the bowel movement may appear clay-coloured.

Blood tests show many abnormalities. Liver enzymes called ALT or AST rise substantially. The bilirubin level may rise and in severe cases, the liver's function may be impaired, causing problems with blood clotting and control of body fluids. Rarely, acute hepatitis B causes enough liver damage to require transplantation or even result in death.

In the majority of cases, however, acute hepatitis B will disappear on its own after several weeks to a few months. Rest is the main treatment.

Chronic hepatitis B

In about 10% of acute cases, hepatitis B will not disappear completely but will progress to a chronic infection. Chronic infections can have several different outcomes depending on how a person's immune system responds. Unfortunately, when infection occurs during infancy, the immune response is poor, and up to 90% of infected infants or 50% of infected children under the age of 5 grow up carrying active hepatitis B virus for life. Often this chronic infection will lead to problems when the person reaches their 30s or 40s. However, some people eventually fully recover, while others will tolerate the infection well for life. Other individuals with lifelong infection eventually develop chronic liver disease, even after decades of living free of symptoms.

In some people who have had chronic hepatitis for years, scarring, or cirrhosis, may develop in the liver. The symptoms of cirrhosis include fatigue, ankle or abdomen swelling, hemorrhoids, bruising, or bleeding. In severe cirrhosis, the veins lining the gastrointestinal system may enlarge and cause bleeding.

When liver function is severely limited, the organ is no longer able to clear the toxic wastes from digesting foods, and the brain becomes affected. This may cause changes in sleep patterns, thinking patterns, or mood patterns.

Men with chronic hepatitis B infection are also more prone to develop liver cancer, called hepatocellular carcinoma. Cirrhosis increases the likelihood of liver cancer occurring. The cancer is common in areas where the infection is rampant.

It is important to remember that chronic hepatitis B will not necessarily cause significant disease in many people. But only after examination and special testing will your doctor be able to know the status of your liver and your hepatitis B infection. Hepatitis infection often changes with time. Because the infection is chronic, your doctor will need to monitor you every so often with examinations and tests.

Stephen Sacks, MD 
in association with the MediResource Clinical Team