Clinical features

The presentation of chronic HBV infection is variable. It may:

• be clinically silent without evidence of a preceding acute attack - diagnosis is made incidentally at the time of blood donation or a routine blood screen.
  
  
• follow an unresolved acute episode which is usually mild - the patient is often generally unwell and complains of fatigue but otherwise is symptom free. There is biochemical evidence of continued viral activity.
  
  
• present as established liver disease - often, there is no evidence of a previous attack. Jaundice, ascites and portal hypertension are common. Encephalopathy is rare. Some present with hepatocellular liver cancer.