Hepatitis B history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2]


50% of adult patients and the majority of infants and children with acute HBV do not present with symptoms. Symptoms may initially be non-specific.[1] Proper and thorough history-taking is important in both acute and chronic HBV infections in order to determine modes of infection transmission, as well as to assess risk factors for the progression of HBV-related liver disease.[2][3]


Part of the initial evaluation for HBV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient's history include:[2]

  • Exposure to blood and/or blood products
  • Injection drug use (IDU)
  • Sexual exposure
  • Occupational exposure
  • Family history of HBV
  • Recent history of invasive procedures performed in non-hospital health care settings, including hemodialysis centers and long-term care facilities[4]

Chronic HBV

In chronic HBV, history taking includes obtaining information regarding factors associated with the progression of HBV-related liver disease.[3] The following aspects should be covered:[3][2]

  • Risk factors for coinfection with HDV, HCV, and HIV
  • Family history of liver disease and HCC
  • Medication history
  • Smoking status
  • Alcohol consumption
  • Drug abuse
  • Sexual activity
  • History of previous HBV treatment (to assess potential for treatment resistance)
  • Antiretroviral drug regimen if coinfected with HIV (to assess potential for treatment resistance)

Patients from Areas of High Endemicity

History-taking among immigrants from regions with a high prevalence of HBV should include questions regarding family history of acute and/or chronic liver disease, rituals in which shared and non-sterile instruments were used (e.g., scarification, piercing), and traditional medical procedures.[2]


Approximately 50% of adults with acute HBV infections are asymptomatic. However, clinical symptoms occur more often in adults than in infants or children, who usually have an asymptomatic, acute course.[1]

Symptoms can include:[1]


  1. 1.0 1.1 1.2 Center for Disease Control and Prevention. Hepatitis B Epidemiology and Prevention of Vaccine-Preventable Diseases 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html
  2. 2.0 2.1 2.2 2.3 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B." Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
  3. 3.0 3.1 3.2 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
  4. Thompson ND, Perz JF, Moorman AC, Holmberg SD (2009). "Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008". Ann Intern Med. 150 (1): 33–9. PMID 19124818.

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