Hepatitis A is a short lasting viruses. The usual pattern of the disease is to be infected, show symptoms and then to recover naturally. Up to ten million cases of infection with hepatitis A virus occur worldwide every year, and is especially prevalent in areas of poor sanitation and hygiene. Most children in developing countries are infected at a very early age, usually without symptoms. It is classified as being a member of the Picornaviridae family as are polioviruses, coxsackieviruses and many of the viruses that cause the common cold.

The disease itself has a wide range of symptoms, from an infection without any noticeable effects through to jaundice and very, very rarely liver failure and death. Occasionally these symptoms are severe and recuperation can take a few months. Hepatitis A does not become a chronic condition and the infection does not last in the body for more than a couple of months.

One study found that co-infection of HIV and HAV leads to higher and longer lasting levels of hepatitis A virus circulating in the blood. (Ida 2002). Although the duration of symptoms was unaffected by HIV status, HIV-infected patients exhibited HAV in the blood for a median of 53 days, compared with 22 days among the previously healthy individuals. The amount of hepatitis A in the blood was significantly higher among those with HIV, regardless of HIV viral load or CD4 count.

Transmission

HAV is transmitted by the faecal-oral route. This means that the faeces of someone with HAV is infectious and if this matter is swallowed by another person they contract the disease. Commonly this happens in countries where untreated sewage is discharged straight into rivers that also supply drinking water or eating uncooked foods that have been washed in contaminated water.

HAV-infected persons are infectious for only a relatively brief period of time. However, many sexual practices facilitate faecal-oral transmission of HAV, and inapparent faecal contamination is not unusual during anal sex. Rimming is an obvious risk for HAV. Measures typically used to prevent the transmission of other STIs (e.g., use of condoms) do not prevent HAV transmission, and maintenance of "good personal hygiene" has not been successful in interrupting outbreaks of hepatitis A.

Tests

Exposure is usually confirmed by an HAV antibody test.

Treatment

Treatment is normally bed rest and taking plenty of fluids until the symptoms have passed. Occasionally immunoglobulin may be given to people who have not been vaccinated but are thought to have been infected with HAV.

Is there a vaccine?

Yes. Hepatitis A vaccination is safe, effective and recommended in people with HIV, though appears most effective if administered when the CD4 count is above 500 (Smith 2002). People with HIV should receive two doses of the vaccine 6-12 months apart. (BHIVA 2004a)

Epidemiology

In 1999, only 1676 cases of HAV infection were reported in England and Wales. However, outbreaks of hepatitis A occur amongst urban gay men in North America have been reported. It is prevalent in many developing countries with poor sanitary infrastructures.