Hepatitis A can turn deadly for fatty liver patients, doctors warn ahead of World Liver Day

As India faces a growing burden of fatty liver disease, doctors are warning that Hepatitis A — often dismissed as a mild and self-limiting infection — can become life-threatening for people already living with liver damage.

Ahead of World Liver Day on April 19, liver specialists said patients with fatty liver disease, cirrhosis or other chronic liver conditions face a far higher risk of severe complications, including acute liver failure, if infected with the Hepatitis A virus.

With nearly one in three Indian adults estimated to have fatty liver disease, the warning comes at a crucial time, as metabolic liver disorders continue to rise across age groups.

Hepatitis A is a viral infection spread through contaminated food, water or poor hygiene. It usually causes fever, fatigue, nausea, abdominal pain and jaundice. While most healthy individuals recover fully without long-term damage, doctors say the picture can be dramatically different for those with pre-existing liver disease.

“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,” said Dr Anurag Shrimal, Director, Liver Transplant at Gleneagles Hospital, Parel.

Fatty liver emerges as a public health threat

Known medically as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), fatty liver disease is increasingly being diagnosed across India. Experts link the rise to obesity, diabetes, elevated blood sugar levels and sedentary lifestyles.

Dr Shrimal cited a meta-analysis of Indian studies involving more than 23,500 adults, which found that around 38.6% of the population may have fatty liver disease. Among high-risk groups such as people with obesity or diabetes, the prevalence rises sharply to 52.8%.

Hospital-based estimates place prevalence at nearly 40.8%, while some community studies using advanced screening tools such as FibroScan have reported rates above 43%.

Separate estimates from the Ministry of Health and Family Welfare suggest fatty liver affects between 9% and 32% of Indians, highlighting major regional and lifestyle differences.

Once viewed as an urban lifestyle disease, fatty liver is now spreading well beyond metros. Studies show prevalence ranges from nearly 9% in some rural communities to over 50% in urban populations, reflecting changing food habits, reduced physical activity and rising metabolic illness nationwide.

Why Hepatitis A becomes dangerous

Doctors say the danger lies in the fact that many fatty liver patients already have a stressed or damaged liver, leaving little reserve to fight a fresh viral attack.

“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,” Dr Shrimal explained.

He added that younger patients without cirrhosis may recover if treated in time. However, those with early cirrhosis or advanced liver injury may not regain normal liver function once deterioration begins.

“In such situations, liver transplantation becomes a life-saving option,” he said.

Silent disease, hidden risk

Doctors also cautioned that fatty liver often progresses silently, particularly among younger adults, who may have no symptoms and assume they are healthy.

That hidden vulnerability can make Hepatitis A especially dangerous.

“Fatty liver often exists without symptoms, 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,” said Dr Rohan Chaudhary, Associate Director, HPB Surgery and Liver Transplant at Gleneagles Hospitals.

He advised patients to seek immediate medical care if they experience jaundice, unusual fatigue or loss of appetite — especially if they have known liver disease.

Rising financial burden on families

The growing liver disease crisis is also placing mounting financial pressure on households.

According to Care Health Insurance, liver disease-related claims have surged 100% over the past three years. Cases among younger individuals are rising by 5% to 10% annually, while Tier 2 and Tier 3 cities are seeing yearly increases of 10% to 15%.

Incidence among women is also climbing by nearly 10% each year. Treatment costs have nearly doubled in the same period, making liver disease one of the most financially demanding health conditions for many families.

“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,” said Manish Dodeja, Chief Operating Officer, Care Health Insurance.

Prevention remains simple

India has already integrated fatty liver screening into its National Programme for Prevention and Control of Non-Communicable Diseases, signaling growing policy recognition of the threat.

However, doctors say awareness, early diagnosis and prevention remain critical.

Since Hepatitis A spreads through the faecal-oral route, experts said basic precautions can make a major difference.

“Maintaining good hygiene, ensuring safe food and water and improving sanitation can significantly reduce the risk,” Dr Shrimal said.

He added that vaccination against Hepatitis A is safe and highly effective, particularly for adults who are not already immune and for those living with existing liver disease.