Autoimmune liver diseases and SARS-CoV-2

Area of Science:

• Immunology
• Hepatology
• Infectious Diseases

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can induce autoimmunity via immune hyperstimulation and molecular mimicry.
• Autoimmune liver diseases (AILDs) encompass conditions like autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC).

Purpose of the Study:

• To review the interplay between SARS-CoV-2, COVID-19, and AILDs.
• To assess SARS-CoV-2's role in triggering liver damage and AILDs.
• To evaluate the potential of SARS-CoV-2 vaccines in inducing autoimmune liver responses.

Main Methods:

• Literature review of studies on AILDs and SARS-CoV-2.
• Analysis of case reports and series concerning COVID-19 in AILD patients.
• Examination of evidence linking SARS-CoV-2 infection/vaccination to AILD development.

Main Results:

• AILD patients do not have higher SARS-CoV-2 infection risk but may experience severe COVID-19 if on immunosuppressants.
• Few cases link SARS-CoV-2 to new-onset AIH, PBC, or AIH/PBC overlap syndrome.
• Post-vaccination AIH-like syndromes are reported, suggesting a potential, though unproven, link.

Conclusions:

• SARS-CoV-2 infection poses a risk for severe COVID-19 in AILD patients on certain treatments.
• Evidence for SARS-CoV-2 causing *de novo* AILDs is limited but warrants attention.
• A potential association between SARS-CoV-2 vaccination and AIH exists, requiring further investigation.