World Hepatitis Day 2021: Experts have recommend that people with COVID-19 need to be screened for Hepatitis. Moreover, every patient who has been treated for COVID-19 should also undergo screening for Hepatitis B.
Around one lakh people land up with Hepatitis B complications every year. Now, this number becomes significant especially during COVID-19 times as we all know that coronavirus can aggravate any primary infections or ailments.
Hepatitis B is a commonly known infection and around 40 million people in India are living with this infection.
The reasons being that COVID-19 is a systematic viral infection involving various parts of the body. Similarly, in COVID-19 the Liver too is affected and so patients will have elevated Liver profiles.
COVID-19 binds to angiotensin-converting enzyme receptors (ACE2). One of the highest concentrations of these receptors is in the Liver, so a person with COVID-19 may have Liver profile abnormality. Some of the data suggest that higher Liver profile abnormality may be an indicator of poor prognosis in COVID-19. Hence, it is important to find out if patients have any pre-existing Hepatitis virus that can cause complications.
Vaccination of Hepatitis is key to build the defense against the illness. HPV vaccines are available in India since the late 90s. However, the awareness among people has been low and so not many people get vaccinated for Hepatitis. Today, Hepatitis vaccines are also part of our immunization program and people must do everything to get informed and get vaccinated.
“Moreover, it is recommended that newborns must receive their first dose of the Hepatitis B vaccine within the first 24 hours of their life. One reason for this is that it is possible for the birth mother to pass the infection onto the baby, which is known as a perinatal infection. Remember, the burden of Hepatitis will reduce only when most people and generations get vaccinated. This will not only reduce people’s chances of developing the illness but can protect them from Liver cancer too,” According to Dr. Geeta Billa, Consultant-Hepatologist, Fortis Hospital, Mulund.
Another important element to note is that 70% of Hepatitis patients are carriers of the virus and do not have an active infection. But 30% have replicating virus and these are the patients who need treatment. Having said that, if a person having inactive Hepatitis gets COVID-19, he or she needs to be treated for Hepatitis too.
“While treating such patients, it is crucial to take a holistic approach in managing both COVID-19 and Hepatitis. If patients are administered with immunosuppressant drugs and steroids such as Tocilizumab, it may aggravate the Hepatitis infections causing related complications. So, healthcare providers also need to be extremely careful while choosing the line of treatment for such patients,” Dr Billa added
According to Dr Kunal Das, HOD And Consultant – Gastroenterology, HCMCT Manipal Hospitals, Dwarka, “SARS-CoV-2 mainly attacks the lungs, but it also causes damage to other organs including the liver, kidneys, intestines, heart as well as the central nervous system. The damage to these multiple organs results in acute liver failure, acute lung failure, cardiac disease, acute kidney injury, mucormycosis as well as Brain disorders (acute flaccid paralysis, epilepsy and acute cerebrovascular disease) and Blood abnormalities (lymphopenia and leukopenia). It is now known to induce complications beyond respiratory system, and occurrences such as liver injury can affect a significant proportion of patients. Minor aberrations in liver function tests (LFTs) are very common and generally associated with the severity of COVID-19.”
Liver dysfunction is a common finding in COVID-19 infection, of limited clinical significance in patients without pre-existing liver disease. Furthermore, liver injury was not an independent risk factor for the outcome of COVID-19, even in patients with chronic liver disease. Even in patients with pre-existing liver diseases like Chronic Hepatitis B, Chronic Hepatitis C, Alcoholic Liver Disease, it has not been shown to damage the diseased liver further or the outcome of COVID-19 among the patients of chronic liver disease or pre-existing liver disease was not worse than others.
Dr Das further explained, “It was found in patients who developed liver injury during hospitalization had higher death rate and ICU admission rates than those without liver injury. It was also observed that patients with liver injury had a significantly prolonged hospital stay, making them susceptible to possible post-admission complications. It must also be kept in mind that being in ICU, especially in cases of severe COVID-19 multiple blood and plasma units are transfused. Each blood or plasma transfused does carry a risk of transfusion associated infections however small it may be. Plasma therapy was once advocated for treatment of severe COVID-19 also carries a small risk of transfusion associated hepatitis.”
The World Gastroenterology Organization (WGO) has published a recent guidance paper for the care of patients with COVID-19 and liver disease and presented a step-wise approach in COVID-19 patients suspected to have a hepatobiliary disease.
Treatment of hepatitis in COVID-19 patients involves treatment of COVID-19 infection, and treatment of hepatitis. Further, it is important of have a diet full of healthy choices including green vegetables, fruits, multi-grain cererals, good amount of liquids and a positive attitude towards life. It is important to keep in mind that many of the medicines used for treatment of COVID-19 may be liver toxic and needs to kept under watch. It is best to avoid alcohol and other liver damaging foods.
“COVID-19 increases the risk of hepatitis but this increase is minor and is of little significance. Furthermore, COVID-19 has not been seen to damage liver of already pre-existing chronic liver disease patients. However, if the severe hepatitis is seen among admitted or ICU patients, it likely to increase the hospital stay of patients especially those who have received multiple blood or plasma transfusions. By taking good food, medicines and COVID-19 appropriate behavior we can keep our liver healthy and safe from COVID-19,” Dr Das concluded.
