Natural history and serological markers: acute and chronic hepatitis B
The subsequent course of chronic hepatitis B is variable. Perhaps 15% to 20% of patients who acquire chronic infection in adulthood ultimately develop cirrhosis. Furthermore, the development of cirrhosis is usually slow, occurring over five to twenty years. Up to 9% may go on to develop HCC.
The risk of complications of hepatitis B is in part related to ongoing active HBV replication.
Infection in childhood may have a different prognosis. Typically, the infection is mild and associated with few symptoms and only minimal elevations of serum aminotransferases. The disease may change once adulthood is reached, with marked fluctuations in its activity and the development of cirrhosis in up to 40% of patients.
A pattern of recurrent reactivation with multiple remissions and recurrences is a particularly severe form of disease which frequently leads to cirrhosis and ultimately to liver failure.
Chronic hepatitis B can lead to HCC. The majority of patients with this cancer also have cirrhosis. In endemic areas of HBV infection, HBV positive patients frequently have silent disease until the development of HCC.
People with active inflammation and cirrhosis (high ALT), where there is a rapid cell turnover, are at increased risk of developing HCC. Ultrasound examinations and regular determinations of alpha fetoprotein can be used to screen for HCC in high-risk populations and in individual patients, particularly those over the age of 40 who acquire HBV infection during childhood and who have cirrhosis. Integration of the HBV genome into hepatocyte DNA may be an important initiating factor in this.
Progressive disease is associated with persistence of viral replication
Remission is associated with loss of active viral replication |