Treatment of Hepatitis A Infection
Treatment for Hepatitis A is entirely supportive, as no specific antiviral therapy exists or is necessary for this self-limited infection. 1, 2
Primary Management Strategy
Supportive care is the sole treatment approach for all patients with hepatitis A, regardless of disease severity or transmission route. 3, 1 The infection resolves spontaneously in the vast majority of cases without requiring specific antiviral medications. 1
Core Treatment Elements
- Provide symptomatic relief focusing on hydration, rest, and management of nausea/vomiting. 1, 4
- Strictly avoid hepatotoxic medications and any drugs metabolized by the liver during the acute illness. 3, 1, 2
- No dietary restrictions are necessary for patients with hepatitis A. 3, 1
- No activity restrictions are required during the illness course. 3, 1
Outpatient vs. Inpatient Management
Most patients can be managed as outpatients with supportive care alone. 1
Hospitalization is indicated only for:
- Patients with severe dehydration from nausea and vomiting preventing adequate oral intake. 1, 4, 2
- Patients developing fulminant hepatitis A with signs of acute liver failure (worsening jaundice, deteriorating liver function, coagulopathy, encephalopathy). 3, 1
Expected Clinical Course
- Most patients recover within 3-4 weeks with complete resolution of elevated liver enzymes. 1
- Peak infectivity occurs 2 weeks before jaundice onset, so patients are often past peak infectiousness when diagnosed. 1
- Discoloration of stool typically resolves within 2-3 weeks, indicating disease resolution. 1
Monitoring for Complications
10-15% of patients experience relapsing disease lasting up to 6 months, with approximately 20% of those having multiple relapses. 1, 2, 5 Even with relapses, overall outcomes remain very good. 1
High-Risk Populations Requiring Enhanced Monitoring
- Patients >50 years old have a case fatality rate of 1.8% (compared to 0.3% overall). 1, 2
- Patients with chronic liver disease (including hepatitis B or C coinfection) are at significantly increased risk for fulminant hepatitis A. 1, 2
- Immunocompromised individuals require enhanced surveillance. 2
Monitoring Parameters
- Monitor liver function tests (ALT, AST, bilirubin, INR) in patients with severe jaundice. 4
- Watch closely for signs of acute liver failure, including prolonged INR and hepatic encephalopathy. 4
Special Considerations
- For cholestatic hepatitis with prolonged jaundice, a short course of rapidly tapered corticosteroids can reduce symptoms. 1
- Liver transplantation may be required for fulminant hepatitis A, though spontaneous recovery occurs in 30-60% of fulminant cases. 1
Critical Pitfalls to Avoid
- Never prescribe medications metabolized by the liver during acute illness, as hepatic function is compromised. 2
- Do not delay recognition of fulminant hepatitis, as early identification is critical for potential transplant evaluation. 1
- Avoid hepatotoxic substances including excessive acetaminophen (>2 g/day) and certain herbal supplements. 3, 2
Post-Exposure Management of Contacts
Contacts exposed to the same source should receive post-exposure prophylaxis within 2 weeks of exposure for maximum effectiveness. 1, 2 Efficacy drops significantly after this window. 2
- For healthy persons aged ≥12 months: Hepatitis A vaccine alone is now preferred over immune globulin. 1, 2
- Use immune globulin (0.02 mL/kg IM) for: Children <12 months, immunocompromised persons, those with chronic liver disease, and those for whom vaccine is contraindicated. 3, 1, 2
- Prophylaxis is recommended for household and sexual contacts of confirmed cases. 2