Abstract
Background/AimsWe 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.MethodsIn 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.ResultsThe 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.ConclusionsUnderlying 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.
Highlights
Coronavirus disease 2019 (COVID-19) is an emerging respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, and rapidly spread to other regions [1]
Underlying chronic hepatitis B (CHB) was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities
Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate, while treatment was not associated with severe clinical outcomes of COVID-19
Summary
Coronavirus disease 2019 (COVID-19) is an emerging respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, and rapidly spread to other regions [1]. The COVID-19 pandemic has claimed 196,107,976 laboratory-confirmed cases and 4,195,176 deaths globally as of July 28, 2021. The World Health Organization reported an overall case-fatality rate of 2.14% [2]. Previous studies have revealed COVID-19 likely induces liver injury, and 14–53% of COVID-19 patients developed hepatic dysfunction, individuals with severe disease [3]. Recent reports have shown that about 2–11% of patients with COVID-19 had underlying chronic liver disease [4]. HBV viruses which cause a global infection and threat public health. As SARS-CoV-2 and HBV both can cause liver damage [6], enhancing our understanding of the risk of SARS-CoV-2 infection in patients with chronic hepatitis B (CHB) is urgently required
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