The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
Hepatitis A is a highly infectious liver infection caused by a type of virus called hepatitis A virus (HAV). Hepatitis means inflammation of the liver, and it is usually caused by an infection (such as hepatitis A, B C, D or E virus) but not exclusively (can be autoimmune, toxic, etc.).
Globally, there are an estimated 1.4 million cases of HAV infection every year. HAV infection is acute (typically lasting 1 to 2 months) and never chronic (unlike hepatitis B and C infection), and is rarely fatal. It does however cause debilitating symptoms and lead to acute liver failure (with high mortality rate).
To detect HAV infection, there are two types of HAV antibody that may be tested, namely HAV IgM and IgG antibodies. When a person is exposed to HAV, the body first produces HAV IgM antibodies. These antibodies typically develop 2 to 3 weeks after first being infected (and are detectable before the onset of symptoms) and persist for about 3 to 6 months. HAV IgG antibodies are produced within 1 to 2 weeks of the IgM antibodies and usually persist for life.
- HAV IgM antibody test detects an acute HAV infection. It is the screening tool used if symptoms or signs arouse suspicion of a HAV infection.
- HAV IgG antibody test determines if a person has immunity to HAV as a result of a past infection or vaccination. It does not tell you if there is a current acute HAV infection.
- A total HAV antibody test detects the presence of both the IgM and IgG antibodies, thus can identify current and past infections, and immunity to HAV.
Signs and symptoms to look for
Signs and symptoms of HAV infection typically appear after 14 – 28 days of exposure to virus. Not everyone with HAV infection will develop these symptoms, such as:
- Yellowing of the skin and whites of the eyes
- Clay-coloured stool
- Dark urine
- Abdominal pain, normally on the upper right side under the lower ribs, next to the liver
- Lack of appetite
- Joint pain
These signs and symptoms may be mild and disappear in a few weeks. But, sometimes HAV infection may cause severe illness that lasts for months. And if you compare the symptoms of HAV to Hep B virus infection, there are no differences. Only the blood test can tell them apart with certainty.
Ways to balance these biomarkers of HAV
No specific medical treatment is available for HAV infection. Your doctor will generally suggest supportive measures such as those suggested for acute hepatitis B infection.
Prevention is better than cure
Vaccination is key to eradicating HAV, together with personal hygiene, proper food handling, participate in safer sexual behaviour. The WHO recommends that ALL newborns are vaccinated on their first birthday. If you are an adult, you should get the vaccine if you :
- Use recreational drugs
- Have travelled to Africa, other Asian countries (except Japan), Eastern Europe, Middle East, the Mediterranean, Central America, South America and parts of the Caribbean.
- Are in the military
- Are a homosexual man
- Work in a nursing home, day care center, or a health care professional
- Have long-term liver disease
- Take blood or blood-related products to treat hemophilia
Balancing the levels through diet
A person with HAV infection must follow a balanced diet and healthy lifestyle to prevent damage to the liver. The diet should include:
- Whole grains – brown rice, oats, barley, quinoa etc.
- Lots of fruits and vegetables
- Lean protein – skinless chicken, fish, beans, and egg white
- Dairy products that are low-fat or non-fat
- Healthy fats – Olive oil, avocados, and nuts
Plenty of fluids should be taken to aid recovery of the liver. It is best to drink water instead of caffeinated drinks like cola and coffee. The goal should be to drink one ounce of fluid every 2 pounds of body weight each day.
Foods to avoid:
- Saturated fats – butter, sour cream, fatty meat, fried foods etc.
- Sugary treats – soda, cake, cookies etc.
- Salty foods
- Alcohol and smoking
When to see the doctor?
A healthcare professional should be contacted if someone experiences signs and symptoms of HAV infection.
If the person had sex with someone infected with the virus.
A vaccine or an antibody injection (immunoglobulin) should be taken within 24 hours of exposure to the virus. This may protect the body from infection.
A doctor should be consulted if the person has recently traveled to a country where there is an epidemic of the disease.
Someone very close has been diagnosed with hepatitis A.
Other laboratory tests to consider
Once diagnosed with a HAV infection, consider the following related liver and general screening biomarkers in order to assess presence and severity of liver damage, track the disease progress, and see that your loved ones are not infected as well.
- LFT (liver function tests)- primarily attacking the liver, HAV infection may cause mild to severe liver infection and deranged liver function. Liver failure is rare but can be tracked through regular LFT during infection.
- General health screen- in particular a complete blood count (CBC) to assess severity of generalized infection through white cell count (looking for high lymphocytes from viral infection). If sexually transmitted, consider also screening for other STDs (sexually transmitted diseases) as HIV, gonorrhoea, chlamydia, herpes, etc. All of which can be done through blood or urine biomarkers.
- Consider screening your family members and those closest to you 2 to 4 weeks after being in contact with you, particularly tracking their HAV IgM antibody for acute HAV infection and HAV IgG for presence of immunity from vaccination or past infection.
Hepatitis A is an extremely contagious liver disease caused by HAV. The virus is spread through food, water or close contact with a person infected with the virus.
HAV is the primary cause of fulminant hepatitis. It has been reported that this virus accounts for 10% and 20% of liver transplants in children in France and Argentina respectively. One-year survival after liver transplantation is 64%. Prevention through vaccination and lifestyle practices (hygiene, food handling, sexual) is key, together with early detection through biomarking your HAV IgM even if no symptoms apparent. Early diagnosis not only allows earlier treatment and prognosis, but also allows you to participate in preventative measures to stop spreading virus to loved ones.
If you want to find out more about Hepatitis A and how you can balance HAV biomarkers, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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