Association between chronic hepatitis B infection and COVID-19 outcomes: A Korean nationwide cohort study

Abstract

Background/Aims We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Methods In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19. Results The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57–0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37–0.66), while treatment was not associated with severe clinical outcomes of COVID-19. Conclusions Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.

Clinical Effect of Hepatitis B Virus on COVID-19 Infected Patients: A Nationwide Population-Based Study Using the Health Insurance Review & Assessment Service Database

“…This is consistent with the other studies with a relatively small number of patients that HBV itself did not affect the clinical outcomes of the COVID-19 after adjusting for comorbidities. 9 11 18 …”

“… 10 However, there are very few reports on the prognosis of COVID-19 in hepatitis B virus (HBV) carriers. 9 11 In addition, there are no reports on whether there is a difference in the prognosis of patients undergoing treatment for HBV. Although many studies are underway to develop a treatment for COVID-19, no treatment has been proven effective yet.…”

“…Recently, several experimental studies reported that nucleos(t)ide reverse transcriptase inhibitors (NRTIs) for HBV treatment were effective against COVID-19 through potential antiviral treatment mechanisms. 11 Unlike Western countries, the prevalence of chronic HBV patients in Korea is high (4%), and there are many chronic HBV patients taking antiviral drugs for HBV. Therefore, the relatively greater number of HBV patients in Korea made it a favorable situation in which to confirm whether HBV infection status and antiviral therapy for HBV infections affected the prognosis of patients with COVID-19.…”

First and second doses of Covishield vaccine provided high level of protection against SARS-CoV-2 infection in highly transmissible settings: results from a prospective cohort of participants residing in congregate facilities in India

“… 18 23 However, it is unclear how infection with HBV influences the risk of SARS-CoV-2 infection; few studies have suggested a lower risk of infection for persons with chronic HBV infection prompting speculation on the possibility of ‘immune exhaustion’ as a result of long standing infection with HBV. 23 24 However, these studies were from the early phases of the pandemic in 2020. Given the constant evolution of the variants, further investigations to study the relationship between COVID-19 and chronic HBV are urgently needed.…”

The Role of Cytokines and Chemokines in Severe Acute Respiratory Syndrome Coronavirus 2 Infections

“…Multiple reports have indicated that some COVID-19 patients have an abnormal liver function; e.g., the American College of Gastroenterology reported that approximately 20%-30% of patients had elevated liver enzymes, and another study from China suggested that 50.7% of SARS-CoV-2-infected patients had liver abnormalities ( 371 ). Of note, elevated liver function results were reported to be associated with moderate-high degree fever and lower T cell function (both CD4 + and CD8 + T cells) ( 371 ), and patients with preexisting liver disease (such as hepatitis B infection) carry a higher risk of developing severe disease ( 372 , 373 ).…”