What to Know About Hepatitis B Reactivation

Hepatitis B reactivation is a serious condition that can result in liver failure if left untreated. If you have previously been diagnosed with a chronic infection, reactivation of the virus is still possible, even after recovery.

Hepatitis B reactivation is characterized as a sudden increase in viral load in a person with prior exposure to chronic hepatitis B.

During acute infection, the hepatitis B virus (HBV) enters the body and seeks out liver cells. Once the virus is introduced, it’s replicated and can potentially cause damage to your liver cells.

The outer envelope is called hepatitis B surface antigen (HBsAg). The inner core of the virus, where the HBV DNA and replication data are stored, is called the hepatitis B core antigen (HBcAg).

Hepatitis B surface antigen (HBsAg) is a protein on the surface of the virus and, when found in your blood, may indicate hepatitis B infection. HBsAg is detectable in the first weeks to months after exposure to the virus.

Further testing is needed to determine immunity to hepatitis B or hepatitis B infection. This includes tests for:

• hepatitis core antibodies (anti-HBc) which are present for life after a hepatitis B infection
• hepatitis B surface antibodies (anti-HBs), which generally indicate immunity (as a result of hepatitis B vaccination or recovery from hepatitis B infection)

95% of adults recover completely from acute HBV infection and do not develop chronic hepatitis B.

As the virus invades the body, it attacks and changes the liver cell’s nucleus, forming covalently closed circular DNA (cccDNA). These changes exist in the cell permanently and can’t be destroyed. In some cases, the virus can cause chronic infection.

Since the cccDNA is always present in the liver cells, a trigger like a compromised immune system can cause HBV reactivation.