Chronic Hepatitis B and COVID-19 Clinical Outcomes in the United States: A Multisite Retrospective Cohort Study

Category	Detail
Condition	Chronic hepatitis B virus (HBV) infection with SARS-CoV-2 coinfection
Key Mechanisms	Direct liver cytopathic effects of SARS-CoV-2, immune activation and cytokine storm, drug-induced hepatic injury, HBV reactivation, and HBV-specific oncogenic pathways
Target Population	Adults aged ≥18 years with chronic HBV infection and SARS-CoV-2 infection in the United States
Care Setting	Multicenter healthcare organizations including academic health centers, hospitals, specialized care services, and outpatient clinics

Individuals with HBV/SARS-CoV-2 coinfection had higher odds of ICU admission and increased 90-day and overall mortality compared to SARS-CoV-2 infection alone.
HBV patients with cirrhosis had 2.0- to 2.5-fold higher odds of adverse outcomes; even those without cirrhosis showed increased mortality risk.
SARS-CoV-2 vaccination significantly reduced 30-day, 90-day, and overall mortality in HBV/SARS-CoV-2 coinfected individuals.

Identify chronic HBV infection status in patients diagnosed with SARS-CoV-2 infection.
Assess cirrhosis status and exclude co-infections such as HIV and HCV for accurate risk stratification.

Prioritize SARS-CoV-2 vaccination in patients with chronic HBV to reduce mortality risk.
Monitor HBV patients closely for progression to severe COVID-19, especially those with cirrhosis.
Consider potential drug-induced liver injury and HBV reactivation during COVID-19 treatment.

Monitor for ICU admission needs and mechanical ventilation in HBV/SARS-CoV-2 coinfected patients.
Track 30-day, 90-day, and overall mortality outcomes in this population.
Evaluate liver function and signs of HBV reactivation during and after SARS-CoV-2 infection.

Increased risk of ICU admission and mortality in HBV/SARS-CoV-2 coinfection compared to SARS-CoV-2 alone.
Higher adverse outcome risk in patients with cirrhosis.
Potential impact of SARS-CoV-2 variant periods on hospitalization risk, with pre-Delta period associated with higher hospitalization.

Adults with chronic HBV infection and SARS-CoV-2 infection in the United States

SARS-CoV-2 vaccination is associated with significant reductions in short-term and overall mortality among HBV/SARS-CoV-2 coinfected patients.

Screen for chronic HBV infection in patients presenting with COVID-19 to identify higher-risk individuals.
Implement SARS-CoV-2 vaccination programs targeting HBV-infected populations to mitigate adverse outcomes.
Closely monitor HBV patients with cirrhosis for severe COVID-19 complications and provide timely intensive care support.
Exclude confounding co-infections such as HIV and HCV when assessing risk and outcomes in HBV/SARS-CoV-2 coinfection.
Consider variant-specific SARS-CoV-2 risks when planning clinical management and resource allocation.

Clinical Scorecard: Clinical Outcomes of Chronic Hepatitis B in Coinfection with COVID-19 in the United States: A Retrospective Cohort Analysis Across Multiple Sites