Hepatitis C does not raise the risk of death from COVID-19

People with hepatitis C were more likely to be admitted to hospital as a result of SARS-CoV-2 infection but no more likely to die when compared to people without hepatitis C of a similar age, research from a US cohort of military veterans shows.

The findings are published in the journal Liver International.

Previous studies of the impact of COVID-19 on people with liver disease have shown that people with decompensated cirrhosis are at higher risk of death from COVID-19 but have not identified any relationship between hepatitis C infection and worse outcomes from COVID-19.

To investigate whether people with chronic hepatitis C infection are at risk of worse outcomes if they contract SARS-CoV-2, researchers associated with the US Veterans Affairs (VA) hospital system used the VA cohort of 237,679 people with hepatitis C. Each patient in the ERCHIVES cohort is matched by age, sex and race with a hepatitis C-negative patient receiving care in the VA system.

They looked for cases of SARS-CoV-2 infection, diagnosed by PCR testing, in people with hepatitis C and their matched controls. All people with hepatitis C had chronic infection confirmed by RNA testing. People co-infected with HIV or hepatitis B were excluded from the analysis.

The researchers identified 975 cases with matched controls. The two groups were well matched by age, sex, race, body mass index and the distribution of co-morbidities associated with increased COVID-19 mortality.

People with hepatitis C were more likely to be current or former smokers and were more likely to have a FIB-4 score above 1.25, indicating some degree of liver fibrosis. However, advanced liver fibrosis (FIB-4 score greater than 3.25) was rare in this cohort; only 8% of people with hepatitis C and 1.4% of the control group had advanced fibrosis.

People with hepatitis C were significantly more likely to be admitted to hospital within 14 days of a positive test for SARS-CoV-2 (24% vs 18.3%, p = 0.002) but no more likely to be admitted to an intensive care unit (13% vs 12.5%). People with hepatitis C did not have a higher risk of death after admission to hospital (6.6% vs 6.5%).

Sub-group analysis showed that age, sex, liver fibrosis and number of co-morbidities did not affect mortality. People with hepatitis C with more advanced liver disease were more likely to be hospitalised and more likely to be admitted to an intensive care unit.

The investigators say it is unclear why hepatitis C further increased the risk of hospitalisation in people with advanced fibrosis. More research is needed to identify if viral or host factors are responsible for raising the risk of poor COVID-19 outcomes in people with hepatitis C, the researchers conclude.