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World Hepatitis Day 2021: Post-Covid-19 Care In Patients With Hepatitis

World Hepatitis Day 2021: Post-Covid-19 Care In Patients With Hepatitis

Do not wait for hepatitis vaccination, diagnosis, and treatment. "Hepatitis Can't Wait" is the theme of World Hepatitis Day 2021.

Written by Editorial Team |Updated : July 28, 2021 11:10 AM IST

COVID-19 pandemic has affected every individual throughout the world directly or indirectly. Over 194 million people are infected, and over 41.6 lakh people have lost their lives due to this highly contagious disease. High infection rates, increased hospitalization and high death rates are present in the elderly and patients with underlying medical conditions such as cardiovascular disease, diabetes, and chronic lung disease. On the other hand, hepatitis infection is widespread globally. Approximately 290 million people are suffering from hepatitis B virus (HBV), and 71 million people have hepatitis C virus (HCV) disease. Given that COVID-19 induces liver injury through several mechanisms, such as direct damage, cytokine storm, aggravation of underlying hepatic conditions, and drug-induced liver injury, patients with hepatitis are at increased risk of developing COVID-19-induced hepatitis complications.

COVID-19 In Hepatitis Patients

As COVID-19 has a significant adverse effect on the liver, hepatitis patients infected with COVID-19 likely have severe liver complications. Studies have concluded that patients with COVID-19 result in acute liver decompensation. Invasion of Coronavirus in liver cells results in direct injury. Cytokine storm results in systemic inflammation leading to multiple organ failure and liver injuries. HBV activation may also be due to certain COVID-19-treatment drugs, such as tocilizumab and baricitinib. Coinfection with SARS-CoV-2 and hepatitis does not significantly affect the COVID-19 outcome. However, such patients may have more severe thrombocytopenia and monocytopenia.

Caring Hepatitis Patients In Times Of COVID-19

The hepatitis patients mustn't skip scheduled follow-up visits due to COVID-19. People undergoing a diagnosis of hepatitis can't wait, people with hepatitis can't wait for treatment, pregnant women can't wait for hepatitis screening, and newborns can't wait for hepatitis vaccination, as waiting may result in adverse outcomes. Avoiding waiting for hepatitis vaccination, diagnosis, and treatment is the theme of World Hepatitis Day, 2021.

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Although most hospitals have strict COVID-19 protocols in place, patients should follow the general guidelines of wearing masks, maintaining social distancing, and sanitizing hands frequently while visiting hospitals. There are no studies available to indicate that HCV direct-acting antiviral (DAA) medications may affect the COVID-19 outcomes. Thus, patients must continue to take medicines as prescribed by their doctors. However, doctors should take care while administering interferon as it may be related to the COVID-19-induced cytokine storm. Hepatitis patients, who are not on DAA and get COVID-19, may avoid the initiation of these drugs until recovery, provided there is no immediate concern about advanced liver disease.

"It is generally recommended that all hepatitis patients contracted with COVID-19 should undergo comprehensive liver function tests. If any of the parameters, especially ALT, AST or bilirubin, have higher levels, the doctor should advise the patients for anti-hepatitis C antibody or hepatitis B surface antigen testing. The doctor should also recommend blood test and ultrasound to diagnose a flare in cases of autoimmune hepatitis."

COVID-19 Vaccination In Hepatitis Patients

Currently, the COVID-19 vaccine is the only medical intervention effective against preventing or at least reducing the complications of COVID-19. There is no data to indicate the adverse effects due to the COVID-19 vaccine in patients with hepatitis. Thus, there is no contradiction of the COVID-19 vaccine in such patients. Hepatitis patients should undergo vaccination at any centre authorized for this purpose. Further, the government should prioritize vaccination for patients with advanced liver failure, liver transplantation, and liver cancer to prevent complications. Hepatitis patients with COVID-19 infection should also get vaccinated after three months of recovery.

Post-COVID-19 Care In Hepatitis Patients

Patients should continue to take hepatitis B medicines during and after the COVID-19 infection. They should discontinue them only if advised by their doctor. As there is an increased risk of liver decompensation in some patients, the doctors should monitor them regularly. Diet also plays a critical role in managing post-COVID-19 complications. Eat a healthy diet that includes fresh fruits and vegetables. The patients should prefer home-cooked food and maintain a healthy weight. Drink sufficient water to remain hydrated and flush out toxins from the body.

Conclusion

Patients with hepatitis should be extra cautious during the COVID-19 pandemic. They must follow all the protocols and get themselves vaccinated. Although the COVID-19 outcomes are not significantly adverse in these patients, the patients may have significant liver injury that prolongs the post-COVID-19 recovery.

(This article is authored by Dr. Aditya Shah, Consultant - Medical Gastroenterology, Manipal Hospital Whitefield)