Background: Acute viral hepatitis is associated with significant hepatic dysfunction including lipid metabolism. Variations in the serum lipid fractions in acute viral hepatitis due to hepatic injury may serve as prognostic marker for severity of hepat ic injury. Methods: Hospital-based prospective study on acute viral hepatitis. Fifty cases of acute viral hepatitis and 50 age and sex matched controls, (>18 years) were studied. Routine biochemical investigation, hepatotropic viral serology and fasting serum lipid fractions were analysed for changes in patients with acute viral hepatitis. Chi-square test was used for comparing variables. A 'p value' <0.05 was considered statistically significant. Results: Baseline parameters were similar between cases and controls (p>0.05). Jaundice (100%) and high coloured urine (100%) were the commonest presentations. Hepatitis A virus (52%) and Hepatitis E virus (30%) were commonest aetiological agents. Serum cholesterol, triglycerides, low density lipoprotein (LDL) were significantly higher (p<0.01) while high density lipoprotein (HDL) was significantly lower (p<0.01) in acute viral hepatitis compared to controls. There was no statistically significant difference in the levels of very LDL between cases and controls (p>0.05). Complications were seen in 7 (14%) cases with hepatic encephalopathy being the commonest (6%). Serum cholesterol, triglycerides, LDL were significantly higher and HDL was significantly lower in hepatitis with complications compared to uncomplicated hepatitis (p<0.01). Conclusion Acute viral hepatitis leads to significant alterations of serum lipid fractions which may serve as an indicator of severity of liver damage and be helpful in assessing the prognosis of patients with acute viral hepatitis.