Hepatitis B is one of the most widespread viral infections in the world, with hundreds of millions of people living with it today. Caused by the hepatitis B virus (HBV), this condition primarily attacks the liver, an organ vital for filtering toxins, storing nutrients, and supporting digestion. While some individuals clear the virus naturally within months, others develop chronic hepatitis B, where the infection persists and silently damages the liver over time. Without proper management, this can lead to liver inflammation, fibrosis, cirrhosis, or even liver cancer, making early awareness, diagnosis, and treatment essential for long-term health.
Understanding what hepatitis B is and how it triggers liver damage over time
Hepatitis B is a viral infection caused by the hepatitis B virus (HBV), which primarily affects the liver. It can spread through contact with infected blood, unprotected sex, or from mother to child during birth. While some people clear the virus naturally, others may develop long-term (chronic) infection, which can lead to serious liver problems over time.
The connection between hepatitis B and liver damage:The liver is one of the body’s most important organs. When HBV infects the liver, it specifically targets hepatocytes, the main cells of the liver. Unlike some viruses that directly destroy the cells they infect, HBV works more subtly by using the cell’s machinery to reproduce, often without immediately killing the cell.According to a study published in PubMed, it is not simply the presence of the hepatitis B virus that causes harm, but the body’s immune response to infected liver cells. Once the immune system recognises these cells as infected, it mounts an attack. As inflammatory cells infiltrate the liver, they trigger cycles of injury. If the infection becomes long-lasting, this ongoing inflammation leads to repeated injury and repair, which over the years can permanently alter the liver’s structure and function.
How hepatitis B damages the liver
1. Persistent inflammationThe immune system plays a central role in liver damage. Each time it recognises infected cells, it tries to eliminate them. This leads to ongoing inflammation, where healthy tissue is repeatedly caught up in the attack.Inflammation is meant to be protective, but when it becomes long-term, it begins to harm the organ itself. The liver’s natural ability to heal is tested again and again, leaving behind subtle scars.2. FibrosisFibrosis is the body’s way of repairing damage. Each time liver cells die, scar tissue is laid down in their place. At first, this may not affect how the liver works, but over time, scar tissue accumulates and spreads. Unlike healthy liver tissue, scar tissue cannot perform essential functions like filtering toxins or producing proteins. If this process continues unchecked, the balance tips, and the liver gradually loses efficiency.3. CirrhosisCirrhosis is the advanced stage of scarring. By this point, much of the healthy tissue has been replaced by thick, nodular scar tissue. The liver becomes hard and shrunken, and blood can no longer flow through it normally.Complications of cirrhosis include:Ascites: build-up of fluid in the abdomen.Variceal bleeding: swollen veins in the oesophagus or stomach that can rupture.Hepatic encephalopathy: confusion and drowsiness due to toxins accumulating in the brain.Liver failure: the liver can no longer perform its vital functions.4. Liver cancer (Hepatocellular Carcinoma)Hepatitis B is one of the leading causes of primary liver cancer worldwide. Unlike cirrhosis, which develops gradually, liver cancer can appear even in people who do not yet have advanced scarring.There are two main reasons HBV can lead to cancer:
- Chronic inflammation: The constant cycle of injury and repair increases the chance of mutations in liver cells.
- Viral integration: HBV’s genetic material can become embedded in the DNA of liver cells. This can disrupt normal controls on cell growth, leading to uncontrolled division and tumour formation.
Understanding the stages of hepatitis B infection: Acute and chronic infection
Not all HBV infections are the same. The body’s reaction depends on the age at which the person is infected and the strength of their immune system.Acute infection refers to the first six months after exposure. Many adults fight off the virus during this stage, often without even realising they were infected. If symptoms do appear, they can include yellowing of the skin and eyes (jaundice), dark urine, tiredness, and abdominal discomfort. Most people recover fully and gain lifelong protection.Chronic infection develops if the immune system fails to clear the virus. This is especially likely when infection occurs at birth or in early childhood. In these cases, the virus remains in the liver for decades. The longer HBV stays in the body, the greater the chance of ongoing inflammation and permanent liver damage.
Who is most at risk of severe liver disease
Not everyone with HBV will experience serious complications. Risk factors include:
- Age at infection: Babies infected at birth have a very high chance of developing chronic infection, while most adults clear it.
- Weakened immunity: People with compromised immune systems (due to illness, HIV, cancer treatment, or organ transplantation) are at greater risk.
- Co-infections: Having hepatitis C, hepatitis D, or HIV at the same time accelerates liver damage.
- Lifestyle factors: Drinking alcohol, smoking, obesity, and poor diet all put extra strain on the liver.
- Gender and genetics: Men are more likely to develop HBV-related liver cancer, and inherited factors may influence progression.
Preventing HBV-related liver damage
- Vaccination: The hepatitis B vaccine is highly effective and provides long-term protection. It is part of routine childhood vaccination in many countries and is also recommended for people at higher risk.
- Regular monitoring: People with chronic hepatitis B should undergo routine blood tests and imaging scans. These can detect early signs of liver damage or cancer, allowing timely treatment.
- Lifestyle protection: Avoiding alcohol, eating a balanced diet, maintaining a healthy weight, and exercising regularly all support liver health. People with HBV should also avoid unnecessary medicines or supplements that may strain the liver.
Frequently Asked Questions (FAQs)
Q1. Can hepatitis B go away on its own?Yes. In adults, most acute infections are cleared naturally within six months. However, if it persists beyond that time, it is considered chronic.Q2. Does everyone with chronic hepatitis B develop liver disease?No. Some people carry the virus without developing significant damage. However, they remain at risk, which is why regular check-ups are vital.Q3. How long does it take hepatitis B to cause liver damage?It varies. In some people, significant damage may take decades to appear. In others, especially those with additional risk factors, it can progress more quickly.4. Can hepatitis B cause liver failure suddenly?Yes, in rare cases, acute HBV can cause sudden liver failure. This is uncommon but very serious and requires urgent medical care.Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.Also read | Chronic inflammation in women increases heart disease risk: Know signs and how it affects the heart
