key: cord-0852487-h81niamz
authors: Odjidja, Emmanuel Nene; Longo, Valentina Laurita; Rizzatti, Gianenrico; Bandoh, Salome
title: Coronavirus Disease 2019 and Viral Hepatitis coinfection: Provide guidelines for integrated screening and treatment
date: 2020-05-15
journal: J Med Virol
DOI: 10.1002/jmv.26021
sha: bdf2c3f192a6ad3eefae21330e7405db7d63d004
doc_id: 852487
cord_uid: h81niamz

The rapid spread of severe acute respiratory syndrome coronavirus 2, the virus, that causes Coronavirus disease 2019 (COVID‐19) threatens global health. Emerging evidence and past experience from other coronaviruses suggests that people with underlying liver disease including viral hepatitis could be at risk of disease severity and mortality. However, with the present relatively low screening rates for the most prevalent viral hepatitis – Hepatitis B and C, many COVID‐19 cases especially in low middle income countries are unlikely to be screened for viral hepatitis coinfection. Without active screening, little will be known about the clinical and epidemiological manifestations which could negatively impact public health efforts. In this commentary, we call for systematic and integrated screening of Hepatitis B and C for COVID‐19 confirmed patients. We also call for guidelines for management and treatment as well as research to understand the epidemiology of coinfection This article is protected by copyright. All rights reserved.

COVID-19 confirmed patients. We also call for guidelines for management and treatment as well as research to understand the epidemiology of coinfection

A major threat to Global Health presently is the rapid spread of the severe acute respiratory syndrome (SARS) 2 virus (SARS-CoV-2) which causes Coronavirus disease (COVID 19), resulting in more than 3,148,417 confirmed cases and 218,368 deaths as at April 29, 2020 1 . Emerging evidence suggests that older patients and those with underlying comorbidities are at increased risk of severe illness and mortality 2 . This implies that those with chronic viral infections like chronic viral hepatitis could be affected.

With an estimated 257 and 170 million people living with Hepatitis B and C respectively, viral hepatitis resulted in 1.34 million deaths in 2015 with the highest burden in the World Health Organisation (WHO) pacific region (24.1 deaths per 100,000), South East Asia (21.2 deaths per 100,000) and the African region (13.7 deaths per 100,000) 3 . In spite of this burden and the increased availability of rapid diagnostic tests, only 9% and 20% of people infected with Hepatitis B and C respectively knew their diagnosis in 2015, of which 8% received antiviral treatments 3 . Presently, The US Center of Disease Control and Prevention (CDC) and the UK government both cite people with underlying liver disease as at risk of severe COVID-19 4, 5 . However, without active screening of people for Viral Hepatitis in SARS-CoV-2 patients, many cases will go undetected and treatment endpoint of coinfection will remain largely unknown. Initial clinical evidence from China reported liver injury among cases signalled by abnormal levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2, 6, 7, 8, 9 . This was found among 14 -53% of cases, of which 2 -11% had underlying chronic liver disease 7 . Previously, an increased likelihood of liver damage and severe hepatitis indicated by elevated levels of HBV and HCV viral load was reported among patients with Severe Acute Respiratory Syndrome (SARS) 10 . Similar predictors of disease severity were reported among patients who had been infected with Middle East respiratory syndrome-related coronavirus (MERS-CoV) with underlying liver disease 10 .

Given the potential increased risk of Hepatitis patients during this pandemic, the interaction of viral hepatitis and COVID 19 is of concern and warrants further investigation to better understand the clinical and epidemiological manifestations. Therefore, we are calling for: first, systematic, integrated testing for Hepatitis B and C among SARS-CoV-2 confirmed patients especially in resource-poor settings where the burden of viral hepatitis is high yet, these tests and liver function tests are not conducted routinely. Second, we call on WHO to provide clear clinical guidelines on management of co-infection of COVID 19 and HBV and HCV patients especially among those who do not meet criteria for antiviral therapy. Third, for expedited clinical and epidemiological research into co-infection of viral Hepatitis and SARS-CoV-2 to inform immediate public health interventions.

World Health Organisation. COVID-19 situation reports

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet

World Health Organisation

COVID-19)

guidance-on-social-distancing-foreveryone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Clinical Characteristics of Coronavirus Disease 2019 in China

Liver injury in COVID-19: management and challenges

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet

COVID-19: Abnormal liver function tests

Liver injury during highly pathogenic human coronavirus infections. Liver International