Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

Abstract

The coronavirus disease 2019 pandemic poses an enormous challenge to healthcare systems in affected communities. Older patients and those with pre-existing medical conditions have been identified as populations at risk of a severe disease course. It remains unclear at this point to what extent chronic liver diseases should be considered as risk factors, due to a shortage of appropriate studies. However, patients with advanced liver disease and those after liver transplantation represent vulnerable patient cohorts with an increased risk of infection and/or a severe course of COVID-19. In addition, the current pandemic requires unusual allocation of healthcare resources which may negatively impact the care of patients with chronic liver disease that continue to require medical attention. Thus, the challenge hepatologists are facing is to promote telemedicine in the outpatient setting, prioritise outpatient contacts, avoid nosocomial dissemination of the virus to patients and healthcare providers, and at the same time maintain standard care for patients who require immediate medical attention.

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

“…48 Patients with NAFLD or steatohepatitis (NASH) usually have diabetes, hypertension and obesity, all of them associated with a severe course of COVID-19. 49 Cai et al analysed 14 patients infected with SARS-CoV-2 and preexisting NAFLD, 6 of which had severe disease and worse outcomes. 7 Ji and colleagues showed that patients with NAFLD had a higher risk of progression to severe COVID-19 and longer viral shedding time.…”

“…EASL-ESCMID currently advises against reducing immunosuppressive therapy in patients with autoimmune liver disease and recommends that reductions should only be considered in case of severe COVID-19 under special circumstances (eg drug-induced lymphopenia or bacterial/fungal superinfection). 49 The World…”

“…The authors suggest that post-transplant metabolic complications might outweigh immunosuppression as a risk factor for development of severe COVID-19disease. In this regard, EASL-ESCMID suggests a reduction of immunosuppressive therapy in post-transplant patients with severe COVID-19 only under special circumstances (eg medication-induced lymphopenia, bacterial/fungal superinfection) 49.…”

Knowledge-based repositioning of the anti-HCV direct antiviral agent Sofosbuvir as SARS-CoV-2 treatment

“…All these sequence and structural modelling evidences strongly support the concept that the SARS-CoV-2 RdRp is much more similar to the one from HCV than the one from negative-sense Influenza and Ebola RNA viruses. Therefore, repositioning of Sofosbuvir (Sovaldi®; Epclusa® by Gilead), the inhibitor of the HCV NS5B RdRp protein, as antiviral in the treatment of the SARS-CoV-2 infection has an extremely high potentiality of success, as recently postulated by others [17], and is suggested as a potential drug for the treatment of COVID-19 in the very recent EASL-ESCMID position paper [18]. This is further supported by the great diversity between the molecular structure of the Sofosbuvir and the inhibitors of Influenza and Ebola viruses currently evaluated in clinical trials (Fig.…”

Management of Hepatocellular Cancer in the time of SARS‐CoV‐2

“…As COVID-19 the disease caused by SARS-CoV-2 continues to have a profound impact on global health, there have been a number of guidelines recently published addressing the management of patients with liver disease during the COVID-19 pandemic including the recently published EASL-ESCMID Position Paper, guidelines issued by the International Liver Cancer Association and the American Association for the Study of Liver Diseases (1)(2)(3). All publications present a sound discussion regarding the challenges face by both patients and clinicians alike in the management of chronic liver disease in the setting of this ongoing pandemic.…”