Hepatitis B is one of five viruses that can infect your liver, causing inflammation. It’s spread through bodily fluids. Most people only have a brief, acute infection. But for some people, it becomes chronic. A chronic infection can do serious long-term damage to your liver. Hepatitis B is preventable with a vaccine, but it has no cure.
Hepatitis B is a viral infection that affects your liver. It causes inflammation in your liver tissues, which is what “hepatitis” means. It begins as an acute infection that’s usually short-lived. But in some people, it turns into a chronic infection that never goes away.
Long-term inflammation does serious damage to your liver over time. It can lead to cirrhosis and liver failure. Like other chronic liver diseases, hepatitis B infection can do this damage without causing symptoms. Many people don’t realize they’re infected.
There are several different viruses that can infect your liver and cause inflammation (hepatitis). They include hepatitis A, B, C, D and E. Each is a little different in how they’re transmitted, how they affect your body and how they’re treated (or prevented).
Some distinguishing features of hepatitis B include:
Hepatitis B is the most common liver infection in the world. As many as 2 billion people (or 1 in 3) have been infected worldwide. Approximately 250 million people worldwide are living with chronic hepatitis B infection, many unaware.
It’s less common in the U.S. than in some other places, thanks to the vaccine. The Centers for Disease Control and Prevention (CDC) estimates approximately 20,000 new acute infections occur in the U.S. each year. An estimated 862,000 people in the U.S. are living with chronic hepatitis B.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Not everyone has symptoms. If you do, they can range from mild to severe. You may have symptoms (or not) during the acute phase of infection, and you may also have them (or not) with chronic infection. You’re still contagious with or without symptoms.
Typical symptoms of infection include:
You may also have symptoms of liver disease, including:
With acute infection, symptoms of liver disease may indicate a more severe reaction than usual. Although many people clear the HBV virus without treatment, you should see a healthcare provider if you have symptoms of liver disease.
With chronic infection, you may have mild or vague symptoms on an ongoing basis, or you may not have symptoms at all for decades. When symptoms appear later, especially symptoms of liver disease, it may indicate your liver is beginning to fail.
Hepatitis B infection comes from the hepatitis B virus (HBV). The virus spreads through bodily fluids. Transmission occurs when fluids from the body of a person who’s infected enter the body of a person who’s uninfected. This might happen through:
HBV can live on surfaces outside of your body for at least seven days. So, used instruments that haven’t been sterilized can still carry the virus. This includes medical instruments and common items like a toothbrush or razor that may have provoked bleeding.
Besides blood, HBV also lives in other bodily fluids, including saliva. But unlike some viruses, hepatitis B isn’t easily transmitted through saliva. That means you aren’t likely to get it from sharing food or eating utensils or from someone coughing or sneezing on you.
You’re more likely to get hepatitis B if you belong to a community where infection is more common. The more people around you may be infected, the more chances the virus has to infect you. Communities with higher rates of infection include:
Chronic hepatitis B develops when your immune system fails to fight off the virus. Most people successfully fight it off during the acute phase of the infection. The acute phase is when your immune system recognizes the virus and launches its attack.
When you have symptoms of illness after an infection, such as fever, nausea and vomiting, those symptoms are part of your immune response. Your immune system is trying to get rid of the virus by purging and burning it out. That’s the acute phase.
Sometimes, some people’s immune systems don’t succeed in clearing the HBV virus during the acute phase. For various reasons, their immune response is weaker than necessary. The acute phase only happens once. If the virus survives, there isn’t another one.
A person might have a weaker immune response to the virus if they:
Sometimes after overcoming an acute hepatitis B infection, something causes your immune system to weaken against the virus later in life. Maybe your immune system was strong at the time of infection, but now you have a condition that weakens it.
When this happens, the once-defeated virus can become active in your body again. Reactivated hepatitis B can be temporary or lasting. But because it tends to occur in immune-suppressed people, it may be especially severe and even cause acute liver failure.
You’re contagious as long as the virus is active in your body. If you have an acute infection, it may last from a few weeks to six months, and you’re contagious that whole time. If you have a chronic infection, you’re contagious as long as it lasts, which is usually for life.
Most complications come from chronic infection, but some people may have complications with acute infection. Though it’s not common, some people experience acute liver failure with acute hepatitis B infection, which is a life-threatening emergency.
Complications of chronic hepatitis B can include:
A healthcare provider will ask you about your symptoms and physically examine you. They might ask about your health history, any history of liver disease in your family or other factors that might make you more susceptible to viral hepatitis.
As you might not have symptoms or any known risk factors, the only way to find out for sure if you have hepatitis B is by testing your blood. Specific blood tests can tell your healthcare provider all they need to know about your condition, such as:
After diagnosis, your provider may want to order additional tests to check how your liver is doing. They might want to look at radiographic images of your liver tissues. In some cases, they might want to take a small sample to examine in the lab (liver biopsy).
If you’ve only recently been exposed to HBV and the virus is still incubating in your body, it might not show up on a blood test yet. A healthcare provider may not be able to tell right away if you’ve been infected, but they can still treat you preventatively.
A healthcare provider may offer you different treatment options based on the status of the infection.
If you have reason to believe you or your child has recently been exposed to the virus, a healthcare provider might suggest prophylactic treatments to help prevent the infection from taking hold. These treatments include:
These treatments are very effective in preventing babies born to parents with chronic hepatitis B from becoming infected. Infants who receive these treatments shortly after birth have a good prognosis, and they can safely breastfeed (chestfeed).
There’s no specific medication to treat an acute hepatitis B infection, and many people won’t need any treatment. But if you’re having severe symptoms, a healthcare provider might monitor you for complications and offer supportive care, such as:
Several medications are available to treat chronic hepatitis B, but they may not be appropriate for everyone. A healthcare provider will recommend treatment based on your condition and risk factors. Your treatment plan may include:
A healthcare provider treating you for chronic hepatitis B will monitor your liver health through regular checkups and testing, ideally every six months. They’ll look for signs of active liver disease that may be affecting your liver’s functioning.
Tests may include:
Healthcare providers have found that current medications for hepatitis B are most effective for people who show signs of active liver disease. This may be only 25% of people diagnosed with chronic hepatitis B, according to the World Health Organization (WHO).
Current medications help boost your immune system and slow down the rate at which the virus reproduces itself. They don’t kill the virus completely, but they can help keep your liver as healthy as possible for as long as possible. They include:
Whether or not you’re taking medication for hepatitis B, you’ll need to take steps to protect your liver from further harm throughout your life. Healthcare providers particularly recommend that you avoid alcohol and maintain a healthy, balanced diet.
Alcohol use and metabolic factors such as a high BMI and high triglycerides are two of the leading causes of liver inflammation outside of infection. When you already have chronic hepatitis, it’s best to limit alcohol, sugar and fat intake to minimize inflammation.
If chronic hepatitis leads to complications such as cirrhosis and liver failure or liver cancer, you might need to have surgery to remove part or all of your liver. Your liver can regenerate itself after a partial resection, as long as enough healthy tissue remains.
If too much of your liver is diseased or failing, however, you’ll need a liver transplant to replace it. Most donated livers come from recently deceased people, and there’s a long waiting list for these. But you can skip the wait if you’re able to find a living liver donor.
The best way to prevent infection is vaccination. If you’re vaccinated against the virus, you won’t have to worry about accidental exposure in your day-to-day life. However, it does take about six months to complete the three doses of the hepatitis B vaccine.
In the short-term, you can reduce your risk by:
If you have active hepatitis B, you can help protect others from infection by:
If you only have a temporary, acute infection, chances are good your immune system will overcome it shortly. Once you’ve recovered from an acute infection, you won’t get it again. A blood test can tell you if you’ve overcome the virus and become immune.
If you don’t overcome it during the acute phase of infection, you’ll develop a chronic infection, which is lifelong. Chronic hepatitis B isn’t curable, but it’s manageable with treatment. A blood test can tell you if you need treatment for a chronic infection.
Death from acute hepatitis B is rare. The death rate from chronic hepatitis B is approximately 15%. About 25% of people who become chronically infected as children die of the disease. About 25% of chronic hepatitis B infections lead to liver cancer.
If you have chronic hepatitis B, it’s very important to stay connected with a qualified healthcare provider, such as a gastroenterologist or a hepatologist (liver specialist). Your provider will keep track of the progress of your disease and advise you on treatment and self-care.
A note from Cleveland Clinic
Most people who get hepatitis B recover shortly on their own. But if you develop a chronic infection, hepatitis B is lifelong. There’s no cure yet for hepatitis B, but regular testing and treatment can minimize the damage it does. Most people can expect to live full, long lives.
Last reviewed by a Cleveland Clinic medical professional on 12/21/2022.
Learn more about our editorial process.