Evolution of Hepatitis A-Related Acute Liver Failure in North America Over 22 Years

Hepatitis A virus (HAV) is a rare cause of acute liver failure (ALF) that carries a relatively good prognosis for recovery. In recent years, overall numbers of HAV cases have declined, likely due to increased hepatitis A vaccination rates. We reviewed the Acute Liver Failure Study Group registry for the number HAV-related ALF cases over 24 years. Overall, the number of HAV ALF cases enrolled steeply declined. After 2010, when we began recording acute liver injury (ALI: INR ≥ 2 but no encephalopathy) an apparent increase in ALI incidence was noted, despite a near absence of ALF cases.