Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers

Kristi L. Koenig, MD; Siri Shastry, MD; Michael J. Burns, MD


Western J Emerg Med. 2017;18(6):1000-1007. 

In This Article

Complications and Special Populations

Less than 1% of cases of HAV infection in adults will progress to fulminant liver failure. Within the U.S., only 3% of cases of liver failure in adults have been attributed to HAV infection.[30,31] Among children in the U.S., HAV infection accounts for up to 1% of cases of acute liver failure.[32] However, in countries with a higher disease incidence, some studies report that HAV infection accounts for up to 60% of pediatric liver failure cases.[33,34] Patients with underlying liver disease, including those with chronic hepatitis B or C, are at greater risk for development of fulminant hepatic failure if they become infected with HAV infection.[35] HAV-related acute liver failure has a spontaneous survival rate of approximately 69%. The remainder of individuals will either successfully undergo liver transplantation or progress to death.[31] Management of acute liver failure due to HAV infection is similar to the management of liver failure due to other causes.

Unlike hepatitis B and C, HAV infection has no chronic carrier state and does not lead to chronic hepatitis or cirrhosis. Persons with chronic liver disease caused by hepatitis B or C who subsequently develop HAV infection may have increased morbidity and mortality.[36] HAV infection can be complicated by the development of cholestatic hepatitis with a protracted period of jaundice. Clinical symptoms include jaundice, pruritus, fever, weight loss and diarrhea for a period of greater than three months. Laboratory tests will show elevated bilirubin, alkaline phosphatase and transaminitis. Cholestatic hepatitis will typically resolve without further intervention and treatment is limited to supportive management.[37,38]

Relapsing hepatitis can complicate some cases of HAV infection. A relapse of symptoms may occur a couple of weeks to several months after the original illness. Symptoms during relapse are typically milder in severity when compared to the initial acute illness. Treatment is focused on supportive care, and resolution typically occurs without further intervention.[39] HAV can rarely lead to the development of autoimmune hepatitis that can have a prolonged and complicated clinical course.[40]