Clinical Outcomes of Chronic Hepatitis B and COVID-19 Coinfection in the US
Overview
This large retrospective cohort study of over 4 million SARS-CoV-2 cases in the US found that individuals with chronic hepatitis B virus (HBV) coinfection had significantly higher odds of intensive care admission and mortality compared to those with SARS-CoV-2 alone. SARS-CoV-2 vaccination markedly reduced mortality risk in the HBV coinfected population, and variant periods influenced hospitalization rates.
Background
Chronic hepatitis B virus (HBV) infection affects millions globally and is a leading cause of liver cirrhosis and hepatocellular carcinoma. SARS-CoV-2 infection primarily targets the respiratory system but can also affect the liver, raising concerns about outcomes in patients with chronic liver diseases. Prior studies suggested increased severity and mortality in SARS-CoV-2 patients with chronic HBV, but data from diverse populations and the impact of vaccination and viral variants remain limited. Understanding these interactions is critical for managing coinfected patients.
Data Highlights
Outcome
Odds Ratio (OR)
95% Confidence Interval (CI)
ICU Admission (HBV/SARS-CoV-2 vs SARS-CoV-2 alone)
1.18
1.02–1.36
90-day Mortality
1.22
1.01–1.41
Overall Mortality
1.18
1.06–1.33
Mortality in HBV/SARS-CoV-2 with Cirrhosis
2.0 to 2.5-fold higher odds
Not specified
Mortality Reduction with Vaccination (30-day)
57% reduction
Not specified
Mortality Reduction with Vaccination (90-day)
54% reduction
Not specified
Mortality Reduction with Vaccination (Overall)
29% reduction
Not specified
Key Findings
Individuals with chronic HBV and SARS-CoV-2 coinfection had significantly higher odds of ICU admission (OR 1.18) and increased 90-day and overall mortality compared to SARS-CoV-2 infection alone.
HBV coinfected patients with cirrhosis exhibited a 2.0 to 2.5-fold higher odds of adverse outcomes, highlighting cirrhosis as a major risk factor.
Even HBV patients without cirrhosis showed increased mortality risk, indicating HBV-specific factors beyond liver disease severity contribute to worse outcomes.
SARS-CoV-2 vaccination in HBV coinfected individuals was associated with substantial reductions in 30-day (57%), 90-day (54%), and overall (29%) mortality.
The pre-Delta SARS-CoV-2 variant period was linked to higher hospitalization odds compared to the Omicron period, but not compared to the Delta period.
Sensitivity analyses excluding HIV, HCV, and transplant cases confirmed the robustness of these associations.
Clinical Implications
Clinicians should recognize chronic HBV infection, especially with cirrhosis, as a significant risk factor for severe COVID-19 outcomes and prioritize early monitoring and management. SARS-CoV-2 vaccination is strongly recommended in this population to reduce mortality risk. Awareness of variant-specific risks may guide resource allocation and patient counseling during different pandemic phases.
Conclusion
Chronic HBV infection independently worsens clinical outcomes in SARS-CoV-2 infection, with cirrhosis amplifying risk. Vaccination effectively mitigates mortality, underscoring its critical role in managing HBV/SARS-CoV-2 coinfected patients.
References
Yu et al 2022 -- Systematic review on HBV and COVID-19 outcomes
Guo et al 2023 -- Meta-analysis of HBV coinfection and SARS-CoV-2 severity
