Medical Management of Hepatitis A Virus (HAV) Infection
Hepatitis A requires only supportive care with no specific antiviral therapy, no dietary restrictions, and no activity limitations for the vast majority of patients. 1
Core Management Principles
The cornerstone of HAV management is supportive treatment, as there are no specific antiviral medications effective against this self-limiting infection. 1, 2
Outpatient Supportive Care
- Symptomatic relief is the primary goal, addressing nausea, vomiting, and malaise as they occur 1
- No dietary restrictions are necessary—patients may eat according to tolerance 1
- No activity restrictions are required—patients may resume activities as tolerated 1
- Hydration maintenance through oral fluids is typically sufficient 1
Indications for Hospitalization
Hospitalize patients only when specific complications arise: 1, 2
- Severe dehydration from intractable nausea and vomiting that cannot be managed with oral rehydration 1
- Signs or symptoms of acute liver failure, including encephalopathy, coagulopathy (INR >1.5), or rapidly rising bilirubin 1, 2
- High-risk patients with underlying chronic liver disease (HBV, HCV, or other chronic hepatopathies) who are at increased risk for fulminant hepatic failure 1
Monitoring and Follow-Up
- Clinical monitoring for symptom resolution over 2-4 weeks is appropriate 3
- Liver function tests should normalize within 2-4 weeks in uncomplicated cases 3
- Watch for relapsing illness in 10-15% of patients, which can occur within the first 6 months 1, 4
- Complete recovery without sequelae is the expected outcome in the vast majority of cases 5
Important Clinical Caveats
Age-Related Considerations
- Older adults have higher risk of acute liver failure and may require closer monitoring 1
- Young children are often asymptomatic but still infectious 4, 6
Avoid Common Pitfalls
- Do not prescribe antibiotics—HAV is frequently misdiagnosed as typhoid fever, peptic ulcer disease, or urinary tract infection, leading to inappropriate antibiotic use 3
- Do not restrict diet or activity unnecessarily, as this provides no benefit 1
- Do not overlook chronic liver disease—patients with pre-existing HBV or HCV are at substantially higher risk for fulminant hepatitis 1
Post-Exposure and Prevention Considerations
While not strictly "medical management" of active infection, clinicians should address contacts:
- Immune globulin (IG) administered to unvaccinated close contacts within 2 weeks of exposure is >85% effective at preventing infection 1
- Contact tracing should identify household members, sexual contacts, and persons with ongoing close personal contact for IG administration 1
- Vaccination should be offered to high-risk groups including men who have sex with men, injection drug users, and persons with chronic liver disease 1, 2