Chronic hepatitis B is a hepatitis B infection that lasts longer than 6 months. Hepatitis B, also known as hep B, is one of five types of viral hepatitis, along with hepatitis A, C, D, and E.

Chronic hep B is most common in children or people with suppressed immune systems.

Keep reading to learn more about chronic hep B, including symptoms, causes, and treatment options.

Hepatitis is an inflammation of the liver. If the inflammation is caused by the hepatitis b virus (HBV), a person is said to have hep B.

In the United States, it’s estimated that about 862,000 people have hep B, and nearly 22,600 people acquire hep B each year. The World Health Organization (WHO) estimates that 296 million people have chronic hep B worldwide.

Hep B transmits through contact with bodily fluids such as blood or semen. It can transmit from mother to child before birth.

Read more about other types of hepatitis.

HBV can cause acute or chronic infection. An acute infection lasts for up to 6 months before your body fights off the virus and may or may not cause symptoms. When symptoms do appear, they tend to last for several weeks.

The infection is known as chronic hepatitis when your body cannot fight off the virus and it lasts longer than 6 months. The chances of developing chronic hepatitis are highest in children under 5.

Chronic infection develops:

  • in more than 90 percent of infected infants
  • in between a quarter to half of infected children ages 1 to 5
  • in about 5 percent of infected adults

Chronic hep B

Chronic hep B develops when your body cannot fight off HBV and the infection lasts longer than 6 months. Once the infection reaches chronic status, it often stays in your body for your entire life. Even if you do not have symptoms, it’s still possible to pass the virus to others.

Many people with hep B do not experience symptoms but can still transmit the virus to others. When symptoms occur, they onset an average of 3 months after exposure. But they can start anywhere between 8 weeks to 5 months after.

According to the Centers for Disease Control and Prevention, 30 to 50 percent of people over 5 have symptoms. Symptoms can include:

The majority of people with chronic hep B do not show any signs of hepatitis or liver disease. Some people develop:

Hep B is passed through bodily fluids like blood and semen. It can also pass from a mother to child before birth. Some of the most common methods of transmission include:

  • sex without a condom or other barrier method
  • sharing needles, including those used for tattoos or piercings
  • transmission to a child during pregnancy.
  • accidental contact with used needles that contain the virus, like in a healthcare setting
  • contact with menstrual, vaginal, or seminal fluid

Saliva can also contain HBV but in smaller amounts. The virus is not passed through coughing, sneezing, or sharing utensils, but it can be passed through a bite wound, according to the Canadian Centre for Occupational Health & Safety.

If you have had HBV for longer than 6 months, it is considered chronic.

Blood tests are needed to confirm a hep B infection. The WHO estimates that only about 10 percent of people living with hep B worldwide are aware of their infection.

A hep B panel of blood tests consists of three parts:

  • Hepatitis B surface antigen test. This test can detect the presence of the virus that causes hep B by identifying proteins on its surface. Further tests are needed to see if you have an acute or chronic infection.
  • Hepatitis surface antibody test. A positive test means that you’re immune to HBV either from a previous infection or from vaccination. It also means that you currently do not have the virus and cannot transmit it to others.
  • Hepatitis B core antibody test. A positive test means you currently have hep B or had a past infection. The results can only be interpreted by knowing the results of the first two tests.

Along with blood tests, a doctor may order an ultrasound or liver biopsy to look for signs of liver damage.

Questions for a doctor or healthcare professional

A doctor or healthcare professional can give you guidelines on how to best manage your chronic hep B. Together, you can develop a plan that minimizes your chances of complications.

Some questions you may want to ask a doctor include:

  • Do I have acute or chronic hep B?
  • What do the results of my blood test mean?
  • Should I be taking medication?
  • What should I do to monitor my disease?
  • Are there any clinical trials that I’m eligible for?

For people with acute hep B infection experiencing mild symptoms, doctors often recommend rest, a healthy diet, and fluids to speed up recovery. Severe symptoms may need to be treated in a hospital.

According to the Hepatitis B Foundation, there are currently seven drugs approved by the FDA to treat chronic hep B in the United States. Not everybody needs to take medication, but some people will need to take medication for the rest of their lives.

These drugs fall into one of two categories:

  • Antiviral drugs. These drugs help reduce inflammation and liver damage. They’re usually taken daily in pill form for at least a year.
  • Immune modulator drugs. These drugs boost your immune system to help your body fight off the virus. They’re administered as an injection over 6 to 12 months.

There’s no cure for hep B, acute or chronic, at the moment. However, clinical trials continue to investigate new treatment options.

Receiving the hepatitis B vaccine can prevent a hep B infection. The vaccine requires 2 to 4 doses, depending on the type you receive.

Some people are at an increased risk of developing hep B. These people include:

  • sexual partners of people with hep B
  • people living in the same house as somebody with hep B
  • people who frequently change sexual partners
  • victims of sexual assault or abuse
  • people seeking testing or treatment for a sexually transmitted infection
  • people with chronic liver disease, kidney disease, hepatitis C, diabetes, or HIV
  • people who have recently traveled somewhere with high rates of hep B
  • people in jails and prisons
  • staff and residents of facilities for developmentally disabled people
  • healthcare workers
  • people who share drug-injection equipment
  • men who have sex with other men

The younger a person is when they first get hep B, the higher their chance of developing a chronic infection. Roughly 1 in 3 children who get hepatitis before age 6 develop a chronic infection.

The majority of people who have hep B as adults fully recover within 1 to 3 months. Children under the age of 5 are at the highest risk of developing chronic hep B infection.

Medications can help manage chronic hep B, but about 15 to 25 percent of people die prematurely from liver cancer, cirrhosis, or liver failure.

More than half of liver cancers are caused by chronic hep B infection. Taking your medications as prescribed and following your healthcare professional’s recommendations can help you minimize your chances of complications.

Hep B is a viral infection that affects your liver. Most adults make a full recovery within 3 months.

Children and people with suppressed immune systems are most likely to develop a chronic hep B infection, which can develop into liver disease.

The best way to prevent hep B is by getting vaccinated. Vaccines are administered in 2 to 4 doses and are 98 to 100 percent effective.