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Most people recover from hepatitis B without treatment. But in a few people it is a serious illness that lasts a long time.

Hepatitis B can make your liver swell and stop it from working properly. Later, you could get liver cancer, or a liver disease called cirrhosis.

You need a healthy liver. Your liver does many jobs to keep you alive. For example, it removes poisons from your blood. If your liver doesn't work properly, you can get very sick.

If you get hepatitis B, you could have it for a short time and get better quickly, or you could have it for a long time. If you have it for a long time it can damage your liver. Doctors call these types of infections short-term (acute) or long-term (chronic).

More than 9 in 10 people who get hepatitis B get short-term hepatitis B (acute hepatitis B). They have mild symptoms and get better quickly. People who have short-term hepatitis B may not even know they have hepatitis B. Their bodies naturally get rid of the virus and they have antibodies in their blood, which stop them from getting infected by hepatitis B again.¹ It's quite rare for people with short-term hepatitis B to get seriously ill because of hepatitis B.

A small number of people who get hepatitis B (between 5 in 100 and 10 in 100) don't get better naturally. They still have the virus in their blood.² This is called long-term hepatitis B or chronic hepatitis B. Long-term hepatitis B is a complicated illness and can affect people in different ways.

Babies and children are more likely to get long-term hepatitis B.³ Hepatitis B is also more likely to become long term if you have an illness that affects your immune system (your immune system includes all the parts of your body that fight off illness). For example, HIV is a disease that can seriously affect your immune system. (For more information, see our section on HIV). If your immune system has been weakened by another illness, it will not be able to protect you against hepatitis B.³

If you are diagnosed with hepatitis B, your doctor will carry out blood tests to see if it has cleared up. If it doesn't clear up within six months, your doctor will probably send you to see a specialist. You might have to have more tests, including a liver biopsy. A liver biopsy is where a doctor takes a tiny part of your liver for tests. This is the best way to see how the hepatitis B virus is affecting you.⁴

Your doctor will probably recommend that you have tests for some other infections that you may have caught, especially hepatitis C. (For more information, see our information on hepatitis C.)

Some people with hepatitis B look and feel well but they can still infect other people. Doctors call them chronic carriers. If you are a chronic carrier, it means you have low levels of hepatitis B in your blood and it is not growing in your liver cells. If hepatitis B is not growing in your liver cells, you will not need treatment. But, in about 1 in 4 chronic carriers, hepatitis B gradually damages their liver. They can go on to get the liver disease cirrhosis or they can get liver cancer. If you are a chronic carrier, your doctor will give you blood tests every six to 12 months to check your liver is not being damaged by hepatitis B.

However, you can still pass the virus on to other people if you are a carrier, so you need to be careful to stop this from happening. For example, it is very important to use condoms when you have sex and not to share needles or anything that could have your blood on it (like razors or jewellery that goes through piercings).⁴ For more information, see What should I do if I have hepatitis B?

Some people with chronic hepatitis B might be quite ill and need drug treatment to limit how much damage the virus does. Drug treatments can also help to get rid of the virus in some people, but it is rare.⁵ For more information, see Drug treatments for hepatitis B.

If you have long-term hepatitis B, you are at greater risk of having problems with your liver.³

• Around 2 in 10 people with chronic hepatitis B go no to get a liver disease called cirrhosis. If you have cirrhosis, your liver doesn't work properly any more.
• Of these people, 9 in 100 will get liver cancer. Hepatitis B is the most common cause of liver cancer in the world.⁵

In some people, their liver stops working completely and they need a new, healthy liver from a donor. They will need to have a type of surgery called a liver transplant.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.