Hepatitis Health Center

Symptoms of infection with hepatitis B virus (HBV), if they appear at all, usually begin 60 to 90 days (although they can appear from 45 to 180 days) after the virus enters the body.

Most people have acute (short-term) HBV infection. In this infection:

• Most people start to feel better after 2 to 3 weeks and recover completely after 4 to 8 weeks. They develop antibodies against a type of HBV antigen that provide lifelong protection against future infection.
• Only a few people (particularly older adults) have long-lasting symptoms.
• A small number of people have symptoms that last for months. They may have signs of abnormal liver function before they completely recover from the acute infection.

About 1 or 2 out of 10 people with acute HBV infection develop joint pain and rashes.¹ In rare cases, HBV causes hives; swelling of the lips, tongue, or other tissue; swelling of the voice box (larynx); or pain in the abdomen.

If you stay infected with HBV for 6 months or longer, you have chronic hepatitis B. The risk of having chronic HBV infection is related to the age at which you first become infected with the virus.²

• Up to 90% of children who are infected at birth develop chronic HBV infection.
• About 30% of children who are infected after birth between the ages of 1 and 5 develop chronic infection.
• About 6% of infected older children, adolescents, and adults develop chronic infection.

About 1.2 million Americans have chronic HBV infection.² Most people with chronic infection have no symptoms. But they can spread the virus to others (especially to people who live with them and to their sex partners) unless they receive treatment that controls the infection.

Although many people with chronic hepatitis B will not develop complications, about 15% to 25% of people with chronic HBV infection will die of cirrhosis or liver cancer.³ Having a lot of virus in the body (a high viral load) increases the risk of developing cirrhosis and liver cancer.

• You are more likely to develop cirrhosis if you carry a specific hepatitis B antigen (called the HBe antigen), are older than 40, and have elevated liver enzymes. For more information on cirrhosis, see the topic Cirrhosis.
• Risk factors for developing liver cancer after chronic HBV infection include being male, having a family history of liver cancer, being over 40 years old, having cirrhosis, and also having hepatitis C.

Other problems that can develop in relation to HBV infection but are uncommon include:

• Hepatitis D (delta) virus infection, which only occurs in those with hepatitis B and may make the HBV infection more severe. Infection with hepatitis D is rare in the United States.
• Fulminant hepatitis, which causes sudden and severe liver failure. A stay in the hospital is needed.
• Inflammation of the blood vessels (vasculitis), which may result in kidney disease, arthritis, belly pain, inflammation of a nerve (mononeuritis), and Raynaud's phenomenon.
• Inflammation and disruption of the kidney (membranoproliferative glomerulonephritis).

People with hepatitis B who engage in high-risk behavior (such as having multiple sex partners or injecting illegal drugs) are at increased risk for hepatitis C and HIV, the virus that causes AIDS.