Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Mar 25, 2025; 14(1): 97482
Published online Mar 25, 2025. doi: 10.5501/wjv.v14.i1.97482
Rising incidence of acute hepatitis A among adults and clinical characteristics in a tertiary care center of Pakistan
Yumna Shahid, Amna Subhan Butt, Iqra Jamali, Faisal Wasim Ismail
Yumna Shahid, Division of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Amna Subhan Butt, Iqra Jamali, Faisal Wasim Ismail, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Co-corresponding authors: Amna Subhan Butt and Faisal Wasim Ismail.
Author contributions: Shahid Y contributed to the design of the study, acquisition of the data, and analysis and writing of the final manuscript; Butt AS contributed to the study conception and design, data analysis and interpretation, reviewed the final manuscript, and made corrections to the manuscript; Jamali I helped retrieve patient data, entry, and analysis; Ismail FW reviewed the study and designed the manuscript; All of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: Ethics approval was obtained from Ethics Review Committee Aga Khan University Pakistan, No. 2024-9479-28215.
Informed consent statement: Informed consent was not required by the ethics review board since the methodology involved review of patient charts.
Conflict-of-interest statement: The authors have no conflicts to interest to declare.
Data sharing statement: Data files can be accessed by reasonable request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/.
Corresponding author: Amna Subhan Butt, FCPS, MBBS, MSc, Associate Professor, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan. amna.subhan@aku.edu
Received: May 31, 2024
Revised: August 29, 2024
Accepted: October 15, 2024
Published online: March 25, 2025
Processing time: 180 Days and 8.7 Hours
Abstract
BACKGROUND

For decades, hepatitis A virus (HAV) has been a leading cause of acute hepatitis among children and was less prevalent among adults. However, recently a paradigm shift has been observed in the epidemiology of HAV, as evident by cases of acute hepatitis due to HAV among adults.

AIM

To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus (HEV) infection.

METHODS

This was a trend analysis conducted at Aga Khan University Hospital Karachi (Sindh, Pakistan) from February 2024 to May 2024. Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed. To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed. Data regarding clinical and laboratory parameters were recorded. The yearly trend of acute hepatitis due to HAV and HEV was analyzed, and comparative analysis was done between HAV and HEV cases among adults.

RESULTS

A total of 396 patients were found to have acute hepatitis during our study duration. HAV was diagnosed in 234 patients (59%) while 157 patients (39.6%) were found to have acute HEV infection. Additionally, acute hepatitis B virus infection was identified in 3 patients (0.7%), whereas acute hepatitis C virus infection was found in 2 (0.5%) cases of acute hepatitis. Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years. The patients with acute HAV were younger than patients with HEV (28 years ± 8 years vs 30 years ± 8 years; P < 0.01). Higher levels of total bilirubin were seen in HEV infection, while higher levels of alanine transaminase were seen in HAV infection. However, a higher proportion of acute liver failure (ALF), coagulopathy, and mortality were observed in HEV.

CONCLUSION

An increase in acute hepatitis A cases among adults shows less severity than hepatitis E, highlighting the need for better sanitation, hygiene, and adult hepatitis A vaccination programs.

Keywords: Acute hepatitis; Hepatitis A virus; Hepatitis E virus; Acute liver failure; Hepatotropic virus; Vaccination

Core Tip: In recent years, there has been a notable shift in the prevalence of viruses causing acute hepatitis. The hepatitis A virus (HAV) is increasingly affecting adults, contrary to its previous predominance among children, while the incidence of hepatitis E virus (HEV) among adults appears to remain unchanged. This change highlights a significant epidemiological transition. Although cases of HEV infection are associated with higher mortality rates, acute liver failure, and coagulopathy compared to those of HAV, signaling distinct impacts between the two viruses in adult populations.