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HAV Severity in Chronic Liver Disease — SCE Infectious Diseases MCQ

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ModerateHepatitisHAV Severity in Chronic Liver DiseaseSCE Infectious Diseases

A 35-year-old man with HIV on ART develops acute hepatitis A (HAV IgM positive) with ALT 1,800 U/L. He also has chronic hepatitis B co-infection (HBsAg positive, on Tenofovir with undetectable HBV DNA). Why is this acute HAV infection potentially more dangerous in this patient?

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Correct answer: D — Pre-existing chronic liver disease (HBV co-infection) increases the risk of severe acute hepatitis and fulminant liver failure from superimposed HAV — HAV vaccination should have been given

Acute HAV superinfection in patients with pre-existing chronic liver disease (HBV, HCV, cirrhosis from any cause) significantly increases the risk of acute liver failure and mortality. This is why HAV vaccination is strongly recommended for all patients with chronic liver disease who are HAV-seronegative. BHIVA recommends HAV vaccination for all susceptible PLWH. This patient's acute HAV was preventable with vaccination. Management is supportive — there is no specific HAV antiviral. Monitor closely for decompensation.

Reference: BHIVA 2024 – Vaccination; NICE CKS 2024 – Hepatitis A; EASL 2024