Background: Cirrhosis of liver is common in north‑east India. Hepatitis A infection in adults with chronic liver disease can cause acute on chronic liver failure associated with high mortality and morbidity. There have been reports of an epidemiological shift in hepatitis A virus (HAV) seroprevalence from South‑East Asia and India. This study evaluated the etiological profile and seroprevalence of anti‑HAV IgG in cirrhosis of liver patients. Patients and Methods: 160 hospitalized adult cases of decompensated cirrhosis of liver and 200 healthy controls were assessed for etiology and their anti‑HAV IgG status by commercially available kits. Results: Most common cause of cirrhosis of liver in our region is ethanol related. 95% of cases and 89% of controls were seropositive for anti‑HAV IgG (f = 0,181, insignificant difference). All cases above the age of 40 years were seropositive. Seroprevalence between sexes (M 97% and F 83.3%) was statistically insignificant. Only age showed a high coefficient of correlation (r = 0.854, statistically significant, P < 0.001). Conclusion: Alcohol is the most common etiology of cirrhosis of liver in north‑east India. Socio‑cultural milieu in our part may play a role with alcohol contributing to a major but preventable heath burden. Anti‑HAV vaccination in our setting is not indicated routinely to cirrhosis of liver patients as it will not be cost‑effective. However, young cirrhotics should be screened for anti‑HAV antibody and if negative, may be offered vaccination. Screening should target young chronic liver disease patients in view of reports of decreasing seroprevalence across Asia as compared to one or two decades back.