# Chronic hepatitis B
What is it
Chronic hepatitis B is a long-term infection with the hepatitis B virus (HBV). The virus settles in liver cells and causes persistent inflammation there. You have chronic hepatitis B if the virus is present in your body for longer than six months and remains detectable.
The difference with acute hepatitis B is important: many adults who get the virus overcome it themselves and recover naturally. But some of the infected develop chronic hepatitis B — their immune system cannot defeat the virus. This can happen silently, without you noticing.
Worldwide, millions of people have chronic hepatitis B. It is an important health issue, especially in certain regions in Africa and Asia, but you also encounter it regularly in the Netherlands.
Causes
The hepatitis B virus is primarily transmitted via blood or body fluids. The main ways are:
- **At birth**: an infected mother can pass the virus to her baby
- **Sexual contact**: the virus is found in semen and vaginal fluid
- **Via blood**: by sharing needles (especially with drug use), or sometimes via tattoos or piercings with non-sterile needles
- **Blood and blood products**: although this has become much rarer in the Netherlands since screening
The virus **cannot** be transmitted via hugs, handshakes, eating or drinking together.
Whether someone develops chronic infection depends heavily on the age at which you contract the virus. Infants and young children who become infected have a much higher risk of chronic infection than adults. In adults, approximately 5–10% develop chronic hepatitis B; in children this percentage can be much higher.
How the disease progresses
Chronic hepatitis B usually follows a slow course. The disease goes through different stages:
**Phase of high viral load with low inflammation activity**
The virus multiplies strongly, but the liver is not or only slightly inflamed. This can last for years or decades. You usually feel well and have no symptoms.
**Phase of active hepatitis**
The inflammation activity in the liver increases. Liver enzymes in the blood rise. This indicates that liver cells are being damaged. This phase can occur regularly or may be absent for years.
**Progression to cirrhosis**
If inflammation persists for years, scar tissue (fibrosis) gradually develops in the liver. Over the years this can become cirrhosis — severe scarring where the liver structure is damaged and function declines. This does not happen to everyone; many people with chronic hepatitis B do not develop cirrhosis.
**Risk of liver cancer**
People with chronic hepatitis B, especially if they have cirrhosis, have an increased risk of hepatocellular carcinoma (liver cancer). This risk is associated with long-term inflammation and the type of virus.
The important thing is that many people with chronic hepatitis B can live for decades without major problems, especially if the disease is detected early and monitored well.
Symptoms by phase
**Early phase (no or mild symptoms)**
Most people with chronic hepatitis B have **no symptoms** for a long time. The infection is often discovered by chance during a blood test.
Sometimes the following can occur:
- Fatigue
- Slight abdominal pain or discomfort in the right flank
- Yellow discoloration of eyes or skin (jaundice) — this indicates more serious liver damage
**Phase with active inflammation**
- Fatigue becomes more severe
- Abdominal swelling
- Dark urine
- Pale-colored stools
- Tendency to bruising and nosebleeds (because the liver produces fewer clotting factors)
**With cirrhosis**
- Severe fatigue
- Fluid retention in abdomen and legs
- Confusion (hepatic encephalopathy, caused by accumulation of toxic substances)
- Bleeding from the esophagus
- Increased susceptibility to infections
It's important to know that you can have **no symptoms for a long time while your liver is still being damaged**. That's why regular monitoring is essential.
What it means for daily life
For many people with chronic hepatitis B — especially in an early stage — daily life doesn't change that much. You can work, exercise, and do leisure activities.
**What you do need to know:**
- **Regular check-ups**: you'll need to schedule appointments for blood tests and possibly liver ultrasounds. This might be a few times a year, depending on your situation.
- **Lifestyle**: many doctors recommend avoiding alcohol or reducing it significantly (alcohol speeds up liver damage), eating healthily, and exercising regularly.
- **Relationships and sexuality**: your partner(s) can get vaccinated against hepatitis B (an effective vaccine). During sexual contact, precautions are recommended.
- **Pregnancy**: people with chronic hepatitis B can become pregnant and have children. The virus can be passed to the child during delivery; that's why extra care is needed (including vaccination and possibly antiviral treatment). This is something to discuss thoroughly with your doctor.
- **Medicines**: some people are prescribed antiviral medications. These must be taken regularly and sometimes cause side effects.
- **Work**: you can practice virtually all professions. Only in certain healthcare professions (where you might come into contact with others' blood) are restrictions sometimes applied — this varies by employer and country.
- **Confidentiality**: hepatitis B is a stigmatized topic. You're not obligated to tell everyone — only people with whom you have blood or sexual contact.
Outlook
The outlook for someone with chronic hepatitis B depends on several factors: the virus variant, how long you've had it, your age, your overall health, and whether you receive treatment.
**Favorable scenarios:**
Many people — especially those whose disease is detected young and well-monitored — have no major problems and don't die from hepatitis B. They can live for years or decades without disease progression.
**Less favorable scenarios:**
Some people develop cirrhosis over 10 to 30 years. Others progress more quickly. Once cirrhosis is present, the risk of liver failure and liver cancer increases.
**Treatment can help:**
Antiviral medications can significantly lower viral load and prevent inflammation. This can slow or halt disease progression. Although the virus doesn't completely disappear, treatment can significantly improve the outlook.
In the general population, it's known that approximately 15 to 40% of people with untreated chronic hepatitis B eventually develop cirrhosis (this varies greatly depending on the patient population and follow-up time). But these figures tell you nothing about your personal situation — your doctor can better assess how it's likely to progress for you.
Vaccines against hepatitis B are effective for prevention, but don't help someone who is already chronically infected.
Frequently asked questions
**Can I pass chronic hepatitis B to my children?**
Yes, especially during delivery. That's why newborns of infected mothers receive a vaccine immediately after birth and sometimes also antibodies (immunoglobulin). This way, infection is usually prevented. You can discuss with your doctor what's best in your situation.
**Can I be cured of chronic hepatitis B?**
Complete recovery — where the virus completely disappears from your body — doesn't happen often spontaneously. With treatment, symptoms and outlook can improve significantly. Some people reach a state where the virus is no longer detectable, but ongoing monitoring remains important.
**Do I have to quit my job?**
No, in most cases you don't. You can keep virtually any job. Only in certain healthcare professions might restrictions apply — this is best discussed with your employer or occupational health service.
**What do I need to tell my dentist or other doctors?**
It's smart to tell your dentist and other doctors that you have chronic hepatitis B. They can take that into account and take precautions. You don't need to shout about it widely, but it's important for your healthcare providers to know.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._