Chronic Liver Diseases and COVID-19

Disclaimer: Not medical or professional advice. Always seek the advice of your physician.

The covid-19 infection has become a serious international problem of community healthcare.

Supporting diseases such as hypertension and chronic lung and heart diseases are considered risk factors for poor COVID-19 outcomes. The effect of the underlying chronic liver disease remains unexplored. Therefore, there is a need for an accurate understanding of the COVID-19 outcomes in patients with chronic liver disease to approximate the risks.

The liver is a vital organ, which has a variety of functions. One of them is to participate in an immune system response. The liver condition affects the progression of infections, diseases and inflammatory processes and the recovery rate.

There is no data on the frequency of Covid-19 infection of patients with chronic liver disease at the moment. There is only limited information about the dependence of Covid-19 progression and the presence of chronic liver disease.

Risk Groups of the Adverse Covid-19 Progression

High-Risk Group

Patients that are suffering from autoimmune hepatitis, receiving immunosuppressive therapy.
Patients with decompensated liver cirrhosis; patients with alcoholic liver disease; patients on the waiting list for liver transplant with progressive chronic liver disease.
Patients after liver transplantation.

Moderate Risk Group

Patients with compensated liver cirrhosis, patient with non-alcoholic fatty liver disease and metabolic dysfunction (diabetes, cardiovascular diseases, arterial hypertension, obesity).

Mechanisms of Liver Damage During Covid-19

Direct cytopathic virus activity (penetration of the liver cell by the virus and cell damage).
Immune inflammation (uncontrolled inflammation, which causes damage to the body's tissues).
Medicinal liver damage (because of taking drugs toxic to the liver).

In patients with severe liver fibrosis or cirrhosis, the high risk of infection is due to immune deficiency. The same is true for patients after liver transplantation and for patients suffering from autoimmune liver diseases, which receive immunosuppressive treatment.

Viral Hepatitis and COVID-19

By the World Health Organization data, every 50th Earth's inhabitant lives with one or another type of viral hepatitis. Viral hepatitis takes approximately a million lives each year.

As of today, there is no convincing data that people with hepatitis B or C have a higher risk of infection with Covid-19. At the same time, serious complications develop more often in these patients if infection occurs.

It was found that the COVID-19 enters the cells of the body through the receptors of the angiotensin-converting enzyme. These receptors are most prevalent in lung cells, but they are also present in liver cells (hepatocytes). It is not excluded that the virus can attack liver cells directly.

Chronic liver disease themselves increase the levels of the enzyme and its receptors. Such patients are more susceptible to the virus. At the same time, disease progression is more complicated.

Such presence of viral hepatitis, most possibly, does not increase the chances of infection. Still, if infected, the disease progression will be more complicated. Therefore, it is essential to follow prophylaxis measures.

COVID-19 Vaccines in Patients With Chronic Liver Disease

During the vaccine's clinical trial, the safety, specifically in patients with liver disease, was not tested. But no data is suggesting that there can be a possible risk to patients with liver disease. Vaccines are often less effective in patients with chronic liver disease and patient after liver transplantation. Still, there is no specific data about vaccines against COVID-19.

British Society of Gastroenterology advises patients with chronic liver disease, autoimmune hepatitis, and patients after liver transplantation to vaccinate against COVID-19 by any available vaccine.

None of the vaccines provides 100% protection. We will receive the full information about safety and effectivity only when these vaccines will be used in clinical practice. The government will conduct ongoing active surveillance of the vaccine's effectiveness and collect data as the vaccination program progresses.

All your question about the COVID-19 vaccine can be discussed individually with your doctor.

What Conclusions can be Drawn?

Chronic liver diseases are amongst the most widespread. Effective observance and treatment of patients with these pathologies are vital for health protection during the pandemic.

The specialists don't have the data confirming that the COVID-19 infecting SARS-CoV2 can cause liver destruction in healthy people. Still, for patients with chronic liver diseases, it is an extra destructive agent.

There is not enough scientific data on the connection of chronic liver diseases with the progression of the COVID-19 infection SARS-CoV19 to draw general conclusions.

The information has already been proven by scientific data.

There is no convincing proof that people living with hepatitis B or C are more susceptible to COVID-19 infection. But their infection is much more severe and contributes to the progression of liver disease.
Patients suffering from non-alcoholic fatty liver disease, suffering from supporting diseases such as diabetes, hypertension, or obesity, are at higher risk of more aggressive COVID-19 progression.
Patients with autoimmune diseases are not recommended to reduce immunosuppressive therapy.
Patients with hepatocellular failure and those after liver transplantation are related to a high-risk group. They are more susceptible to COVID-19 infection and severe progression of the disease.

During the pandemic, all patients with chronic liver disease are advised to pay more attention to their health. In the presence of any ailments, please immediately contact your treating hepatologist.