The Course of COVID-19 Infection in Patients With Chronic Hepatitis Delta

In coronavirus disease 2019 (COVID-19), older age and co-morbidities are associated with mortality. Among liver disease aetiologies alcoholic liver disease was associated with mortality. Chronic hepatitis delta (CHD) had not been studied. The current study explores course of COVID-19 disease in chronic hepatitis B (CHB) and CHD. This retrospective study included CHB and CHD patients from the gastroenterology departments of Hacettepe and Koç University Hospitals. COVID-19 was confirmed via PCR testing for SARS-CoV-2 RNA. Data on liver disease severity, including MELD-Na and Child-Pugh scores, as well as vaccination status, were collected. A total of 618 patients (343 M/275 F) were evaluated, comprising 540 CHB patients (27 [5%] cirrhotic) and 78 CHD patients (43 [55%] cirrhotic). COVID-19 was diagnosed in 47 CHB patients (8.7%) and 12 CHD patients (15.4%), p = NS. Hepatic reactivation occurred in 3 CHB patients (6.3%) and 4 CHD patients (33%), (p = 0.018). Reactivation was more frequent in cirrhotic patients than non-cirrhotic patients (50% vs. 4%, p = 0.0009). One cirrhotic CHB patient decompensated, while one cirrhotic CHD patient died and another developed hepatic decompensation. The majority of cirrhotic CHB patients (96.3%) were receiving nucleos(t)ide analogues (NAs), whereas only one cirrhotic CHD patient was on treatment for Hepatitis D virus (HDV). Although the small number of CHD patients and COVID-19-positive cases limits definitive conclusions, CHD patients may experience a more severe course of COVID-19 compared to CHB patients. This may be due to the higher proportion of cirrhotics among CHD patients and the lack of effective antiviral treatment for HDV.