Approximately 85% of individuals infected with hepatitis A virus (HAV) have full clinical and biochemical recovery within a 3-month period with nearly all individuals recovering within 6 months.[45]Koff RS. Clinical manifestations and diagnosis of hepatitis A virus infection. Vaccine. 1992;10 (suppl 1):S15-7.
http://www.ncbi.nlm.nih.gov/pubmed/1335649?tool=bestpractice.com
In about 10% to 20% of symptomatic patients, a prolonged and relapsing course can occur lasting several months with persistent fever, pruritus, diarrhoea, jaundice, weight loss, and malabsorption.[19]Cuthbert JA. Hepatitis A: old and new. Clin Microbiol Rev. 2001 Jan;14(1):38-58.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88961
http://www.ncbi.nlm.nih.gov/pubmed/11148002?tool=bestpractice.com
[20]Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 14th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2021.
https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
Death from hepatitis A is rare. In 2021, US case fatality rates were unreliable for ages 0-44 years, 0.06 per 100,000 people for ages 45-64 years, and 0.13 per 100,000 people for ages ≥65 years.[13]Centers for Disease Control and Prevention. Viral hepatitis surveillance report - United States, 2021. Aug 2023 [internet publication].
https://www.cdc.gov/hepatitis/statistics/2021surveillance/hepatitis-a.htm
In <1% of patients, acute liver failure occurs characterized by worsening jaundice, coagulopathy, and encephalopathy.[35]Taylor RM, Davern T, Munoz S, et al. Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 2006 Dec;44(6):1589-97.
http://www.ncbi.nlm.nih.gov/pubmed/17133489?tool=bestpractice.com
[36]Ajmera V, Xia G, Vaughan G, et al; the Acute Liver Failure Study Group. What factors determine the severity of hepatitis A-related acute liver failure? J Viral Hepat. 2011 Jul;18(7):e167-74.
http://www.ncbi.nlm.nih.gov/pubmed/21143345?tool=bestpractice.com
These patients require immediate referral for liver transplant assessment. The 1-year survival rate for patients who receive liver transplantation for acute HAV infection is 69%.[46]Jung DH, Hwang S, Lim YS, et al. Outcome comparison of liver transplantation for hepatitis A-related versus hepatitis B-related acute liver failure in adult recipients. Clin Transplant. 2018 Jan;32(1).
http://www.ncbi.nlm.nih.gov/pubmed/29044729?tool=bestpractice.com