Hep B not a predictor of worse COVID-19 outcomes

Pre-existing hepatitis B virus (HBV) infection does not appear to worsen COVID-19 outcomes, a study from China showed. However, significant differences in blood counts and biochemistry were observed in patients with both conditions compared with those with COVID-19 mono-infection. 

“SARS-CoV-2 and HBV co-infection did not significantly affect the outcome of COVID-19,” said the authors.

“However, at the onset of COVID-19, SARS-CoV-2 and HBV co-infected patients presented with more severe monocytopenia and thrombocytopenia, as well as more disturbed hepatic function in albumin production and lipid metabolism,” they said.

Study participants were 106 patients hospitalized for COVID-19 at Renmin Hospital of Wuhan University, Wuhan, China, between January 22 and March 30, 2020. Of these, 50 had pre-existing HBV. Fifty-six patients with SARS-CoV-2 mono-infection were age-, gender-, and comorbidity-matched with patients with SARS-CoV-2 and HBV co-infection. Also included were 57 patients with HBsAg-positive, HBeAg-negative chronic HBV and 57 healthy individuals, who served as controls. Complete blood counts and serum biochemistry were conducted. Age and gender were comparable among the four groups.

The proportion of patients with moderate (54 percent vs 51.79 percent), severe (42 percent vs 46.43 percent), or critical (4 percent vs 2.17 percent) SARS-CoV-2 infection was comparable between the SARS-CoV-2 and HBV co-infection and the SARS-CoV-2 mono-infection groups. Number of recovered cases (n=46 vs 52) or duration of hospitalization (median 25 days for both) also did not differ between the co-infection and SARS-CoV-2 mono-infection groups. [Liver Int 2020;doi:10.1111/liv.14774]

White blood cell (WBC) count was significantly lower in patients with COVID-19 compared with controls, primarily due to a reduction in lymphocytes, with no between-group difference in neutrophil count.

“As a low lymphocyte count has been associated with increased disease severity and mortality in COVID-19, COVID-19 patients with pre-existing HBV infection may require increased clinical oversight,” the authors pointed out.

Red blood cell count and haematocrit and haemoglobin levels were also significantly lower in patients with COVID-19 vs controls, though HBV infection did not affect the levels.

Patients with SARS-CoV-2 and HBV co-infection had significantly lower monocyte and higher CD8 T-cell counts compared with those with SARS-CoV-2 mono-infection.

WBC below the lower limit of normal was more common among patients with SARS-CoV-2 and HBV co-infection than with SARS-CoV-2 mono-infection.

While platelet counts were in the normal range in all groups (125–350x10⁹/L), the count was significantly lower in patients with SARS-CoV-2 and HBV co-infection (179x10⁹/L). “This suggests that SARS-CoV-2 and HBV co-infected patients have a higher risk of developing thrombocytopenia,” said the authors.

Patients with COVID-19 had significantly elevated cytokine levels compared with healthy controls. However, inflammatory cytokine levels did not vary between patients with SARS-CoV-2 and HBV co-infection and those with SARS-CoV-2 mono-infection. Low albumin levels occurred in patients with COVID-19 regardless of HBV infection. Patients with COVID-19 had significantly elevated ALT levels, while those with SARS-CoV-2 and HBV co-infection had significantly higher AST levels vs controls.

Patients with COVID-19 also had lower total and HDL-cholesterol levels, particularly those with SARS-CoV-2 and HBV co-infection, who also exhibited differences in LDL-cholesterol (vs healthy controls) and triglyceride levels (vs patients with SARS-CoV-2 mono-infection or healthy controls). Patients with SARS-CoV-2 and HBV co-infection also had elevated creatine kinase levels, which suggests an increased risk of disease deterioration.

Following COVID-19 recovery, patients with SARS-CoV-2 and HBV co-infection demonstrated significant elevations in lymphocyte, monocyte, basophil, eosinophil, T, B, and NK cell counts, and reduction in AST and albumin production.

“Taken together, our data suggests pre-existing HBV infection has minimal effect on the severity of COVID-19,” the authors said. However, they noted that the potential SARS-CoV-2–related liver injury could present some challenges. They also suggested the potential benefit of HBV antiviral therapy prior to immunosuppressive therapy for COVID-19 in order to reduce HBV flares.