Treatment of Acute Hepatitis A
Acute hepatitis A requires supportive care only, as no specific antiviral therapy has been proven effective for this self-limited infection. 1, 2
Diagnosis Confirmation
- Confirm diagnosis by testing for IgM antibody to hepatitis A virus (anti-HAV IgM) in patients presenting with acute viral hepatitis symptoms 1, 2
- Serologic confirmation is essential because hepatitis A cannot be distinguished from other viral hepatitis based on clinical presentation alone 1
Primary Treatment Approach
The cornerstone of management is supportive care focusing on:
- Rest, hydration, and symptomatic relief 1, 2, 3, 4
- Avoid medications that cause liver damage or are hepatically metabolized 2
- Hospitalize patients who develop dehydration from nausea and vomiting 2
The disease is typically self-limited, with most patients recovering within 2 months, though 10-15% experience relapsing illness over 6 months 1, 4. Importantly, hepatitis A does not progress to chronic infection or chronic liver disease 3, 4.
Monitoring for Severe Disease
Close surveillance is critical for identifying progression to acute liver failure:
- Monitor liver function tests including ALT, AST, bilirubin, and INR in patients with severe jaundice 2
- Watch for signs of acute liver failure: prolonged INR and hepatic encephalopathy 1, 2
- Coagulation factor assays (prothrombin time and factor V levels) are the best predictors of fulminant hepatic failure 5
While fulminant hepatic failure occurs in only 0.14-0.35% of hospitalized cases, it represents a medical emergency 5. Patients progressing to grade 4 encephalopathy have survival rates up to 67% with medical management, though some require emergency liver transplantation 5.
Special Considerations
Corticosteroid therapy has shown outcome improvement in severe cases 6, though this remains an area with limited high-quality evidence. Several molecules including AZD 1480, zinc chloride, and heme oxygenase-1 have demonstrated reduced viral replication in vitro but lack clinical validation 6.
Common Pitfall
Do not confuse acute hepatitis A management with hepatitis B or C—unlike these viruses, hepatitis A has no role for antiviral medications 1. The AASLD explicitly states that viral hepatitis A-related acute liver failure must be treated with supportive care only, as no virus-specific treatment has been proven effective 1.
Post-Exposure Management
For contacts of confirmed cases, administer hepatitis A vaccine as soon as possible 2. Consider immune globulin within 2 weeks of exposure for close contacts at high risk of complications 2.