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Rationale:
- Hepatitis A is confirmed by serologic testing to detect IgM anti-HAV.
- In most persons, IgM is detectable by the time a person is symptomatic.
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Evidence:
- IgM anti-HAV can be detected in nearly 100% of patients with acute hepatitis A and remains positive in most persons for 3
to 6 months (89).
- IgM anti-HAV may remain positive for 12 months in up to 25% of individuals (90; 91; 92).
- In the setting of an outbreak, testing for HAV RNA during the period from viral exposure to development of IgM anti-HAV might
be useful in persons with acute hepatitis of unknown etiology (93).
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Comments:
- Assays to detect total anti-HAV (IgG anti-HAV) are not helpful for diagnosing acute hepatitis A because IgG anti-HAV persists
for many years and may reflect past infection.
- Hepatitis A does not cause chronic infection.
- Relapsing hepatitis A occurs in approximately 3 to 20% of patients with acute hepatitis A (94).
- To improve the predictive value of a positive anti-HAV IgM test, limit testing to those persons whose exposure history or
clinical features are consistent with hepatitis (95).
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Brian J. McMahon, MD, MACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Catherine M. Dentinger, FNP, MS has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Hepatitis A
> Diagnosis
