Hepatitis B reactivation is a serious condition that can result in liver failure if left untreated. If you have previously been diagnosed with a chronic infection, reactivation of the virus is still possible, even after recovery.

Hepatitis B reactivation is characterized as a sudden increase in viral load in a person with prior exposure to chronic hepatitis B.

During acute infection, the hepatitis B virus (HBV) enters the body and seeks out liver cells. Once the virus is introduced, it’s replicated and can potentially cause damage to your liver cells.

The outer envelope is called hepatitis B surface antigen (HBsAg). The inner core of the virus, where the HBV DNA and replication data are stored, is called the hepatitis B core antigen (HBcAg).

Hepatitis B surface antigen (HBsAg) is a protein on the surface of the virus and, when found in your blood, may indicate hepatitis B infection. HBsAg is detectable in the first weeks to months after exposure to the virus.

Further testing is needed to determine immunity to hepatitis B or hepatitis B infection. This includes tests for:

  • hepatitis core antibodies (anti-HBc) which are present for life after a hepatitis B infection
  • hepatitis B surface antibodies (anti-HBs), which generally indicate immunity (as a result of hepatitis B vaccination or recovery from hepatitis B infection)

95% of adults recover completely from acute HBV infection and do not develop chronic hepatitis B.

As the virus invades the body, it attacks and changes the liver cell’s nucleus, forming covalently closed circular DNA (cccDNA). These changes exist in the cell permanently and can’t be destroyed. In some cases, the virus can cause chronic infection.

Since the cccDNA is always present in the liver cells, a trigger like a compromised immune system can cause HBV reactivation.

The symptoms of HBV reactivation are often the same as the initial HBV infection.

If symptoms do occur, they may last a few weeks to several months and can include:

Some people experiencing chronic infection are asymptomatic until the onset of cirrhosis or end-stage liver failure.

HBV reactivation can happen spontaneously, but immunosuppressive therapies more commonly trigger it.

People who have chronic hepatitis B have a higher risk of reactivation than those who have a resolved hepatitis B infection.

You may also be more likely to experience reactivation if you:

  • undergo chemotherapy for cancer
  • take immunosuppressive therapy, including Rituximab and other drugs that target B lymphocytes, high dose steroids, and anti-TNF agents
  • receive treatment for a coinfection with hepatitis C
  • have HIV and have discontinued antiretroviral drugs that also have activity against HBV
  • undergo solid organ or bone marrow transplantation

One of the most common ways of detecting reactivation is through monitoring alanine aminotransferase (ALT). It’s typical to see a rise in ALT levels 2 to 3 weeks before a rise in HBV DNA.

Certain serologic tests can also be used to identify reactivation.

These tests check for the presence of HBsAg, anti-HBs, and anti-HBc to determine if you have hepatitis B, if you’re immune as a result of a prior infection, and if the infection is acute or chronic.

If you’re currently at a higher risk for reactivation and have planned immunosuppressive therapies, close monitoring is necessary to ensure HBV levels remain below the baseline.

HBV infection and reactivation are often treated with antiviral therapy, though this varies from person to person. These medications fight the virus and reduce its ability to cause liver damage.

Common antiviral medications include:

In some cases, interferon injections may be used.

It’s important to keep your care team up to date on any underlying conditions you may have and any treatments you’re currently using.

It may not seem like your eye doctor, for example, needs to know about health conditions treated by your primary care physician, but it’s crucial that everyone is informed.

This ensures that your clinicians have all of the information necessary to create the best care plan for your individual needs.

Avoiding certain medications or scheduling more frequent screening can help reduce the risk of reactivation and ensure prompt identification if it does occur.

HBV DNA remains in the body even after the virus is successfully treated. Reactivation is possible, especially if you have a weakened immune system.

Careful screening and treatment can help reduce the risk of hepatitis B reactivation, as well as reduce the risk of long-term complications associated with HBV.

If you’re experiencing symptoms of reactivation, consult with a healthcare professional as soon as possible. They can advise you on any next steps.

Catasha Gordon is a sexuality educator from Spencer, Oklahoma. She’s the owner and founder of Expression Over Repression, a company built around sexual expression and knowledge. You can typically find her creating sex education materials or building some kinky hardware in a fresh set of coffin nails. She enjoys catfish (tail on), gardening, eating off her husband’s plate, and Beyoncé. Follow her everywhere.