Prevalence of Viral Hepatitis in Unselected, Consecutively Enrolled Patients Hospitalised for SARS-CoV-2

Abstract

Diagnosing people living with chronic viral hepatitis is challenging due to the absence of symptoms as long as liver decompensated cirrhosis come out. The aim of this retrospective study was to evaluate the prevalence of HBV and/or HCV infections in a non-selected population, hospitalised for SARS-CoV-2 infection in a tertiary care hospital in Northern Italy. During the study period 1,429 patients were admitted to hospital for SARS-CoV-2 infection, serologic tests for HBV and/or HCV were available for 382 (27%) patients and 3 were excluded due to their previous known serologic status. Among 379 patients, 235 (62%) were male, median age was 70 years (range 21–103), 360 (95%) were Caucasian. Among them, 372/379 (98%) were screened for HBsAg, 320/379 (84%) for HBcAb. HBsAg was positive in 2/372 (0.5%, 95% CI 0.0006–0.02) patients (only in one HBV-DNA was performed that was negative), while HBcAb was found positive in 55/320 (17%, 95% CI 0.13–0.22). Among 370/379 (98%) patients screened for HCV, 11/370 (3%, 95% CI 0.02–0.05) had positive HCV-Ab. Five out of 11 (45%) were tested for HCV-RNA that resulted positive in two patients (0.5%, 95% CI 0.0006–0.02). Considering this data, even though the screening was performed in only 27% of study population, a tailored screening in people with known risk factors for hepatitis might be preferable to universal screening in low prevalence areas. Also a prompt diagnostic workout should begin in case of clinical or laboratory suspicion of hepatitis and in those starting immunosuppressive treatments.

A territory‐wide opportunistic, hospital‐based HCV screening in the general population from northern Italy: The 1969–1989 birth‐cohort

“…Another point raised by our study is the high percentage of subjects with positive anti‐HCV but negative HCV–RNA values (71.7%). This data is in line with other reports, as rates of undetectable HCV–RNA in anti‐HCV positive subjects identified by opportunistic screening programs in recent studies vary between 64% and 82%, 11–14 to be lower in individuals unaware of their status (0%–33%) 8,17,12–14 . Although patients with a sustained virological response (SVR) should not have been included in our study, we cannot exclude that some of them did still participate to this screening program.…”

“…Another point raised by our study is the high percentage of subjects with positive anti-HCV but negative HCV-RNA values (71.7%). This data is in line with other reports, as rates of undetectable HCV-RNA in anti-HCV positive subjects identified by opportunistic screening programs in recent studies vary between 64% and 82%, [11][12][13][14] to be lower in individuals unaware of their status (0%-33%). in Milan, 4 out of 5 (80%) positive subjects initially affirming to be unaware of their HCV status declared to have already been treated…”

“…Results from those studies were comparable, despite potential differences in the target population: "healthy" individuals undergoing anti-COVID-19 vaccination in the first study versus people hospitalized for any reason in the second one. 8,14 Other studies conducted in unselected people (any age) reported prevalence of active HCV infection of 0.5% and 0.7% in hospitalized subjects, 11,12 and of 0.07% in those undergoing anti-SARS-CoV-2 testing or vaccination. 13 Not unexpectedly, taking together all these studies reveal prevalence of viraemic patients lower than that reported in studies conducted before 2019, [15][16][17] TA B L E 3 Main patients' characteristics and screening outcome according to recruitment setting and birth cohort.…”

Prevalence of undiagnosed hepatitis B virus infection in patients with COVID-19A single center retrospective study

“…The prevalence of 3.1% HBsAg that we found in our study of outpatients presenting with COVID-19 at a tertiary care hospital in Romania is in line with the data previously reported for Romania, which placed the country at intermediate prevalence, with 4.4% of the general population testing positive for HBsAg, [ 11 ] and higher than that reported from a comparable study performed in Italy in a slightly smaller patient group, where 0.5% of 372 patients tested positive for HBsAg. [ 12 ] In our study, only six of our 16 HBsAg-positive patients were aware of their HBV status, and the overall rate of new HBV diagnoses was 1.9% in the entire patient cohort, suggesting that there might be quite a large proportion of undiagnosed patients that we still need to actively identify and link to care. Importantly, one third of these newly diagnosed cases of HBV infection also met the criteria for starting antiviral treatment, highlighting the need for earlier access to screening, to allow timely therapeutic intervention.…”

“…Furthermore, we found a high prevalence (23%) of anti-HBc, indicative of past HBV infection, higher than the prevalence of 17% reported among 320 subjects from a similar patient population tested in Italy. [ 12 ] The following patient characteristics were considered to be highly suggestive for history of prior HBV infection and should trigger an in-depth liver and viral hepatitis workup: older age, hypoalbuminemia, decreased platelet counts either alone or followed by increased platelet counts at day 14, and increased lactate dehydrogenase. We further found that patients with evidence of prior HBV infection displayed particular dynamics of liver-related laboratory parameters over the course of COVID-19, specifically: higher liver cytolysis (increased transaminases) and cholestasis (increased bilirubin), lower ALB levels, and lower platelet counts, compared to patients without evidence of prior HBV infection; they also displayed higher BUN levels, indicating the need to closely follow the kidney function in this subset of patients.…”