Clinical Outcomes of COVID-19 Patients With Chronic Hepatitis B Virus Infection Still Need To Be Explored

Abstract

We read with great interest the study by Zou et al.1Zou X. et al.Clin Gastroenterol Hepatol. 2020; (Epub ahead of print)Google Scholar Their results are interesting and important, but we do have some concerns about them. In this study, the authors found that liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chronic hepatitis B virus (HBV) coinfection was associated with severe illness and an overall poor prognosis. However, these results are built on a single cohort, meaning that coronavirus disease 2019 (COVID-19) patients with HBV coinfection have not been compared with patients with SARS-CoV-2 infection alone. One of the major concerns for clinicians is whether COVID-19 patients with a specific disease have a more severe illness and a worse prognosis than those without, which is not provided in the current study. In terms of the data presented in this study, the results of HBV DNA test have not been given, and therefore the clinical stage of included patients cannot be determined clearly. Because most patients in this study are likely to be classified as patients with hepatitis B e antigen–negative chronic HBV infection,2European Association for the Study of the Liver.J Hepatol. 2017; 67: 370-398Abstract Full Text Full Text PDF PubMed Scopus (2914) Google Scholar the clinical outcomes of patients with acute HBV infection or with active HBV replication remain unclear. Furthermore, the authors described the information of patients who took oral antivirals on admission. It is not clear whether these patients continued to take antivirals during hospitalization, which may affect patients’ clinical outcomes. We also found that many antivirals, antibiotics, and steroids were used for treatment in this study, and the use of these drugs may further influence the results; drug-induced liver injury cannot be ruled out in this study.3Pawlotsky J.M. Nat Rev Gastroenterol Hepatol. 2020; https://doi.org/10.1038/s41575-020-0328-2Crossref PubMed Scopus (38) Google Scholar We suspect that immune dysfunction caused by chronic HBV infection may play an important role in the progression of disease in COVID-19 patients. Several studies showed that HBV persists with virus-specific and global T-cell dysfunction mediated by multiple regulatory mechanisms.2European Association for the Study of the Liver.J Hepatol. 2017; 67: 370-398Abstract Full Text Full Text PDF PubMed Scopus (2914) Google Scholar Furthermore, depressed immunity is manifested by decreased immune cell populations, and reduced CD4 (+) and CD8 (+) T-cell counts were predictive of disease progression in patients with COVID-19.4Zhang X. et al.Nature. 2020; https://doi.org/10.1038/s41586-020-2355-0Crossref Scopus (493) Google Scholar Thus, the presence of coinfection leading to possible immune disorders and suppression may influence the disease progression in COVID-19 patients. Because the current study did not present data on patients’ immune function, more research is needed to confirm this hypothesis and explain the specific mechanism in the future. Characteristics of Liver Function in Patients With SARS-CoV-2 and Chronic HBV CoinfectionClinical Gastroenterology and HepatologyVol. 19Issue 3PreviewCoronavirus disease 2019 (COVID-19) is a major global health threat. We aimed to describe the characteristics of liver function in patients with SARS-CoV-2 and chronic hepatitis B virus (HBV) coinfection. Full-Text PDF