People with hepatitis C were more likely to be admitted to hospital
as a result of SARS-CoV-2 infection but no more likely to die when compared to
people without hepatitis C of a similar age, research from a US cohort of
military veterans shows.
The findings are published in the journal Liver International.
Previous studies of the impact of COVID-19 on people with
liver disease have shown that people with decompensated cirrhosis are at higher
risk of death from COVID-19 but have not identified any relationship between
hepatitis C infection and worse outcomes from COVID-19.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
To investigate whether people with chronic hepatitis C
infection are at risk of worse outcomes if they contract SARS-CoV-2, researchers
associated with the US Veterans Affairs (VA) hospital system used the VA cohort
of 237,679 people with hepatitis C. Each patient in the ERCHIVES cohort is
matched by age, sex and race with a hepatitis C-negative patient receiving care in the
They looked for cases of SARS-CoV-2 infection, diagnosed by
PCR testing, in people with hepatitis C and their matched controls. All people
with hepatitis C had chronic infection confirmed by RNA testing. People co-infected
with HIV or hepatitis B were excluded from the analysis.
The researchers identified 975 cases with matched controls.
The two groups were well matched by age, sex, race, body mass index and the distribution
of co-morbidities associated with increased COVID-19 mortality.
People with hepatitis C were more likely to be current or
former smokers and were more likely to have a FIB-4 score above 1.25,
indicating some degree of liver fibrosis. However, advanced liver fibrosis
(FIB-4 score greater than 3.25) was rare in this cohort; only 8% of people with
hepatitis C and 1.4% of the control group had advanced fibrosis.
People with hepatitis C were significantly more likely to be
admitted to hospital within 14 days of a positive test for SARS-CoV-2 (24% vs
18.3%, p = 0.002) but no more likely to be admitted to an intensive care unit (13%
vs 12.5%). People with hepatitis C did not have a higher risk of death after
admission to hospital (6.6% vs 6.5%).
Sub-group analysis showed that age, sex, liver fibrosis and
number of co-morbidities did not affect mortality. People with hepatitis C with more
advanced liver disease were more likely to be hospitalised and more likely to
be admitted to an intensive care unit.
The investigators say it is unclear why hepatitis C further increased the risk of hospitalisation in people with advanced fibrosis. More research is needed to identify if
viral or host factors are responsible for raising the risk of poor COVID-19
outcomes in people with hepatitis C, the researchers conclude.