Acute hepatitis B, or HBV that lasts less than six months, is no longer prevalent in the United States, probably the result of early vaccinations. It does occasionally occur, however, and its flulike symptoms—fever, abdominal upset, nausea, decreased appetite, vomiting, and changes in the way things taste and smell—resemble symptoms associated with other hepatitis infections. In some cases, the individual experiences symptoms that make it clear the immune system is fighting off the HBV, such as muscle and joint aches, too much protein in the urine, or a rash.
Acute hepatitis B often goes undetected, largely depending on the age of die person at the time of infection. The incubation period can be as long as five to six months, and symptoms are vague. If HBV is suspected, the doctor will perform liver function tests (LFTs), which often demonstrate that levels of transaminases (AST and ALT) are elevated. The levels usually decrease over the course of the disease. If the physician retests and finds that the AST and ALT are still elevated after six months, it is likely that the illness has progressed from acute to chronic hepatitis B. The blood tests used to determine whether a person has chronic hepatitis B are persistent hepatitis B sAg, or “surface antigen,” and the hepatitis B DNA, or “viral load.” In more than 95 percent of adult acute HBV cases in the United States, the immune system will have conquered the disease and the virus will be gone. Reassurance will come when the above tests return negative results.
In about one percent of acute HBV cases-—-often those acute HBV patients who already have some form of underlying liver disease-—-the disease may progress to fulminant hepatitis B, a rare but severe occurrence characterized by jaundice, sudden liver failure, coagulopathy (inability to clot blood), and progressive encephalopathy or coma. These patients require an immediate liver transplant to survive.
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When the HBV continues for more than six months, it is termed chronic hepatitis B. This version of hepatitis B has the potential to be more serious because patients who are afflicted with it can suffer liver damage, cirrhosis, and even liver cancer.
Fortunately, progression from acute to chronic HBV occurs only in about 5 percent of acute adult HBV patients. Researchers aren’t sure why some acute HBV patients are able to expel the virus from their bodies, while others are not, but it appears that the immune system is better at eliminating HBV in adults than in children. The assumption is that the immune systems of children simply have not matured enough to perform this substantial task, and the numbers affirm it: infants have only a 5 to 10 percent chance of expelling the hepatitis B virus, while children will eliminate it 25 percent to 35 percent of the time, and about 95 percent of adults with acute HBV experience complete spontaneous cures before the virus has a chance to become chronic.
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For relatively few people, chronic HBV will progress to cirrhosis before they notice serious symptoms, such as accumulated fluid in the abdomen (ascites), alteration in mental status (encephalopathy), or, in extreme cases, primary liver cancer (hepatocellular carcinoma, or HCC). Even more unusual are the individuals with chronic hepatitis B who develop cancer in the liver even if it is working normally and shows no evidence of cirrhosis.
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