What are the consequences of hepatitis B infection?
About 2/3 of hepatitis B infections are symptomatic. One to six months after infection, flu-like symptoms with fatigue, aching limbs, nausea, vomiting, diarrhea and fever occur. A few days later, the typical yellow coloration (icterus) of skin and eyes appears in about 1/3 of cases.
This results in a dark coloration of the urine. An uncomplicated infection heals after a few weeks. Rarely are there severe courses that end fatally.
In about 1/3 of the cases the disease proceeds asymptomatically, i.e. it is not noticed by the affected person. In about 90% of the cases the hepatitis B disease heals without any consequences. However, the main reason why it is so dangerous is that it can also take a chronic course.
This is the case in 5-10% of those infected. The rate of chronicity decreases with age. In newborns it is extremely high at around 90%.
This underlines the need for adequate care and counseling of patients with hepatitis B during pregnancy. The greatest risk of chronic hepatitis B is the development of cirrhosis of the liver (shrunken liver). Cirrhosis of the liver is a severe and incurable disease with limited life expectancy.
In addition, the presence of liver cirrhosis increases the risk of developing liver cancer (hepatocellular carcinoma, HCC). If patients with chronic hepatitis B have cirrhosis of the liver, the 5-year probability of developing liver cancer is 10-17%. Patients with chronic hepatitis B have an approximately 100 times higher risk of developing hepatocellular carcinoma compared to healthy individuals.
Both liver cirrhosis in advanced stages and liver cancer are diseases that drastically reduce life expectancy. Up to 10% of people who become infected with hepatitis B develop a chronic course. The first phase of acute infection often goes unnoticed.
Why certain people develop a chronic course has not yet been sufficiently clarified. It is certain, however, that the risk of chronicity is higher the more one is at the time of the initial infection. In infected newborns, for example, about 90% of the diseases run chronic.
With small children the risk for a chronic illness is still about 50%. Acute hepatitis, which occurs shortly after infection with the pathogen, is fatal in very few cases. In 0.5-1% of cases, however, severe courses of lethal liver failure have been described.
Chronic hepatitis B, on the other hand, is in many cases associated with a reduced life expectancy. Patients may be symptom-free for years, although they suffer from the chronic infection. If liver cirrhosis or even hepatocellular carcinoma develops, the disease will in most cases be fatal over a shorter or longer course.
