Hepatitis A can turn severe in patients with fatty liver, warn doctors

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(File Photo) Make us preferred source on Google Whatsapp twitter Facebook Reddit PRINT With nearly one in three Indian adults estimated to have fatty liver disease, doctors are warning that Hepatitis A, commonly considered a mild and self-limiting infection, can trigger acute liver failure in patients with underlying liver conditions, including fatty liver and cirrhosis. The warning comes ahead of World Liver Day on April 19, at a time when India is witnessing a steady rise in metabolic liver disease across age groups. Hepatitis A is a viral infection transmitted through contaminated food, water or poor hygiene, typically causing symptoms such as fever, fatigue, nausea, abdominal pain and jaundice. “While it remains mild in most healthy individuals and resolves without long-term consequences, it can lead to serious complications in patients with underlying liver disease such as fatty liver or cirrhosis,” says Dr Anurag Shrimal, Director, Liver Transplant at Gleneagles Hospital, Parel. Fatty liver is a public health concern Metabolic dysfunction-associated steatotic liver disease (MASLD), fatty liver disease in common parlance, is increasingly being diagnosed in India, largely driven by obesity, diabetes, high blood sugar and sedentary lifestyles. Dr Shrimal says that a meta-analysis of Indian studies covering over 23,500 adults has estimated that about 38.6 per cent of the population has fatty liver disease, with prevalence rising to 52.8 per cent among high-risk groups such as those with obesity or diabetes. Hospital-based estimates suggest prevalence of around 40.8 per cent, while some community studies using advanced diagnostic tools, such as FibroScan, have reported rates of over 43 per cent. Other estimates from the Ministry of Health and Family Welfare suggest that fatty liver disease affects between 9 per cent and 32 per cent of the population, indicating wide variation across regions and lifestyles. While earlier considered largely an urban condition, recent data suggest that fatty liver is no longer confined to metros, with prevalence ranging from about 9 per cent in some rural populations to over 50 per cent in urban cohorts, reflecting broader lifestyle changes across the country. Why Hepatitis A is a risk for fatty liver “Fatty liver means the liver is already stressed and damaged; adding an acute infection like hepatitis A reduces its ability to function, results in severe inflammation and leads to liver failure. This is what we call acute-on-chronic liver failure, where an already damaged liver suddenly deteriorates following an acute infection,” explains Dr Shrimal. He further assures that while younger patients without cirrhosis may recover with timely treatment, those with early cirrhosis or significant liver damage may not regain normal liver function once it declines. “In such situations, liver transplantation becomes a life-saving option,” he says. Why Hepatitis A is often underestimated Doctors also caution that Hepatitis A is often underestimated in adults, particularly those with pre-existing liver conditions. That’s why Dr Rohan Chaudhary, Associate Director, HPB Surgery and Liver Transplant at Gleneagles Hospitals, advises patients to seek medical attention if they experience symptoms such as jaundice, fatigue or loss of appetite, particularly if they have known liver disease. “Fatty liver often exists without symptoms (undiagnosed), particularly in younger individuals, leading to a false sense of security. A person may appear healthy but their compromised liver makes them susceptible to severe consequences if they acquire Hepatitis A,” he says. The broader data on liver disease in India points to a rising clinical and economic burden. According to Care Health Insurance, there has been a 100 per cent increase in liver disease-related claims over the past three years, alongside a 5 to 10 per cent annual rise in cases among younger individuals. Cases in Tier 2 and Tier 3 cities have increased by 10 to 15 per cent annually, while incidence among women is rising by nearly 10 per cent each year. Treatment costs have also nearly doubled during this period, making liver disease one of the more financially demanding conditions for households, linking the rising disease burden with increasing economic strain. “We have observed a clear shift in both profile and intensity. Cases are rising sharply, the younger population is getting impacted and the financial impact on households is becoming significantly heavier. This is not just a clinical issue; it is increasingly an economic one as well. It is, therefore, critical for individuals to periodically review their health coverage and ensure their sum insured keeps pace with these evolving risks,” Manish Dodeja, Chief Operating Officer, Care Health Insurance. India has already integrated fatty liver screening into its National Programme for Prevention and Control of Non-Communicable Diseases, signalling policy-level recognition of the issue, but doctors say greater awareness and early detection are essential. They emphasise that prevention of Hepatitis A remains straightforward, as the infection spreads through the faecal-oral route. “Maintaining good hygiene, ensuring safe food and water and improving sanitation can significantly reduce the risk,” Dr Shrimal says, adding that vaccination is available and highly effective, particularly for adults who are not already immune and those with existing liver conditions.