Hepatitis A Infection

Hepatitis A (HAV)

• Most individuals have a clinical resolution within 6 months of infection, and some within 2 months.
• HAV does not lead to chronic infections.
• Children younger than 6 years of age are typically asymptomatic.
• Symptoms may include fever, jaundice, scleral icterus, hepatomegaly, and pruritus.

Hepatitis B (HBV)

• Approximately 70% of patients are subclinical or asymptomatic.
• Younger patients are most likely to be asymptomatic.
• Symptoms may include jaundice, dark urine, white stool, abdominal pain, fatigue, fever, chills, loss of appetite, and pruritus.
• Goals of treatment: suppress HBV replication, prevent disease progression to cirrhosis and HCC, and prevent HBV reactivation in patients with inactive HBV infections.
• All patients with cirrhosis require HBV treatment, regardless of DNA or ALT levels.

Hepatitis C (HCV)

• Approximately 70% of patients are asymptomatic.
• Symptoms may include jaundice, dark urine, white stool, abdominal pain, fatigue, fever, chills, loss of appetite, and pruritus.

Laboratory Findings

• ALT/AST elevations:
  • HAV: >1000 IU/L, ALT > AST
  • HBV: 1000-2000 IU/L, ALT > AST
  • HCV: highly variable, can be approximately 1000 IU/L, ALT > AST
• Bilirubin:
  • HAV: elevated and preceded by aminotransferase elevations
  • HBV: can be within normal or elevated
  • HCV: elevated and preceded by aminotransferase elevations
• Virus-specific tests:
  • HAV: IgM anti-HAV
  • HBV: IgM anti-HBc, HBsAg
  • HCV: HCV RNA (+) or quantifiable, HCV antibody reactive within 12 weeks of exposure