Longitudinal changes of liver function and hepatitis B reactivation in COVID‐19 patients with pre‐existing chronic hepatitis B virus infection

Abstract

Aim: With the current coronavirus disease (COVID-19) pandemic and high endemic levels of chronic hepatitis B virus (HBV) infection worldwide, it is urgent to investigate liver function changes of COVID-19 patients with chronic HBV infection, and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in turn affects the course of chronic HBV infection. Method: We undertook a retrospective study based on 347 COVID-19 patients (21 vs. 326 with vs. without chronic HBV infection). With the propensity score matching (PSM) method, we yielded 20 and 51 matched patients for the HBV group and the non-HBV group, respectively. Results: At the end of follow-up, all of these 71 patients achieved SARS-CoV-2 clearance (P=0.1). During the follow-up, 30% versus 31.4% in the HBV group versus non-HBV group progressed to severe COVID-19 (P=0.97). After PSM, the longitudinal changes of median values for liver biochemistries were not significantly different between the two groups. In the HBV group versus non-HBV group, 35% (7/20) versus 37.25% (19/51) (P=0.86) had abnormal alanine aminotransferase at least once during hospitalization, 30% (6/20) versus 31.37% (16/51) had abnormal aspartate aminotransferase (P=0.91), 40% (8/20) versus 37.25% (19/51) had abnormal γ-glutamyltransferase (P=0.83), and 45% (9/20) versus 39.22% (20/51) had abnormal total bilirubin levels (P=0.91). Moreover, three patients in the HBV group had hepatitis B reactivation. Conclusions: Liver dysfunction presented in COVID-19 patients with/without chronic HBV. Moreover, those COVID-19 patients co-infected with chronic HBV could have a risk of hepatitis B reactivation. It is necessary to monitor liver function of COVID-19 patients, as well as HBV-DNA levels for those co-infected with HBV during the whole disease course.

Interaction between hepatitis B virus and SARS-CoV-2 infections

“…HBV coinfection did not affect the course and prognosis of COVID-19. In another study by Liu et al [ 23 ], 21 (6.4%) patients with COVID-19 and HBV coinfection were included, and 51 matched COVID-19 patients without HBV were used for comparison. They explored the independent impact of chronic HBV infection on the progression to severe COVID-19 and found that HBV did not delay SARS-CoV-2 shedding and did not increase the risk of progression and poor outcomes related to SARS-CoV-2.…”

“…In a retrospective study[ 23 ] of 21 patients with SARS-CoV-2 and HBV coinfection, 19 patients were tested for HBV DNA viral load at least twice during hospitalization. Of the 19 patients, three patients developed HBV reactivation and manifested as a rapid increase in HBV DNA viral load from undetectable to a high level.…”

Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury

“…In a retrospective study, the authors analyzed liver function parameters including ALT, AST and TBIL in COVID-19 patients with or without HBV infection and found no significant differences between the two groups[ 56 ]. Another study reached a similar conclusion and further proved the longitudinal changes of median values for liver biochemistries were not significantly different between the two groups either[ 57 ]. These findings indicated that SARS-CoV-2 will not exacerbate liver injury in patients with HBV co-infection.…”

“…In their cohort, COVID-19 cases with HBV coinfection had higher levels of ALT, AST, TBIL and ALP than the COVID-19 cases without HBV coinfection, showing that inactive HBV carriers with SARS-CoV-2 coinfection are at risk of greater liver injury. Moreover, SARS-CoV-2 was reported to induce HBV reactivation, which may cause severe liver injury in patients with coinfection[ 57 , 59 ]. In addition, a case of COVID-19 with Epstein-Barr virus coinfection was reported recently.…”

Effect of SARS-CoV-2 coinfection was not apparent on the dynamics of chronic hepatitis B infection

“…In this study, we reported the sequential levels of HBV-related markers during the acute infection of SARS-CoV-2. Previous studies on patients coinfected with SARS-CoV-2 and HBV have shown that the existence of coinfection could not aggravate the liver injury or extend the duration of hospitalization compared with HBV infection alone ( Chen et al, 2020 ; Liu et al, 2020 ). However, these studies failed to depict levels of all HBV-related markers during the infection and clearance of SARS-CoV-2 infection.…”