CLINICAL FEATURES AND NATURAL HISTORY

Acute HBV infection is frequently asymptomatic, but patients may experience influenza-like symptoms, loss of appetite, abdominal pain, jaundice, and dark urine. Extrahepatic symptoms include skin rashes, arthralgias, and arthritis.1,3 Rarely, patients develop severe, life-threatening inflammation of the liver, known as fulminant hepatitis.3,7 Approximately 95% of immunocompetent adults infected with HBV recover completely, while 5% become chronically infected.18 In contrast, 90% of infants infected at birth and 25% to 50% of children infected between 1 and 5 years old will develop chronic infection.4

Table 1 lists groups at increased risk for chronic hepatitis B infection, including all people born in regions with a 2% or higher prevalence of HBsAg--much of Asia, Africa, Eastern Europe, the Middle East, and the Pacific Islands--where infection during birth or childhood is more likely to occur.19 In countries where prevalence is lower than 2%, high-risk groups include people who have multiple sex partners, men who have sex with men (MSM), injection drug users (IDUs), household and sexual contacts of people with chronic hepatitis B, people with HIV or diabetes, infants of HBV-infected mothers, and those receiving hemodialysis or cytoxic or immunosuppressant therapy.1,3,14,20 Coinfection with hepatitis B increases risk of AIDS or death among people infected with HIV.21

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