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Hepatitis B associated with severe COVID-19: a nationwide cohort study in Sweden
Frida Jakobsson1, Osvaldo Fonseca-Rodríguez1, Hanna Jerndal1
1Department of Clinical Microbiology, Umeå University, 90185, Umeå, Sweden.
Insights
Chronic hepatitis B virus (HBV) infection increases the risk of severe COVID-19, especially in patients with cirrhosis. HBV status is crucial for COVID-19 risk assessment.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Individuals with severe liver disease face higher risks from COVID-19.
- The specific impact of chronic hepatitis B virus (HBV) infection on COVID-19 severity is not well-established.
Purpose of the Study:
- To evaluate the association between chronic HBV infection and severe COVID-19 outcomes.
- To determine if cirrhosis in HBV patients modifies COVID-19 severity risk.
Main Methods:
- Nationwide Swedish data from February 2020 to April 2021 were analyzed.
- Laboratory-confirmed COVID-19 cases were identified and categorized by chronic HBV infection status (with or without cirrhosis).
- Multivariable logistic regression adjusted for demographics, comorbidities, vaccination, and socioeconomic factors.
Main Results:
- A cohort of 1,057,174 COVID-19 cases included 2,902 with chronic HBV.
- Chronic HBV infection was linked to a 24.2% increased risk of severe COVID-19 (aOR 1.242).
- The risk of severe COVID-19 was substantially higher in HBV patients with cirrhosis (aOR 2.463) compared to those without (aOR 1.183).
Conclusions:
- Chronic HBV infection, particularly with cirrhosis, elevates the risk of severe COVID-19.
- Geographic and socioeconomic factors also impact COVID-19 outcomes in HBV patients.
- HBV status should be integrated into COVID-19 risk stratification strategies.
Purpose:
Individuals with severe liver disease are more vulnerable to severe COVID-19, but the association between chronic hepatitis B virus (HBV) infection and severe COVID-19 remains unclear. This study evaluates this relationship.
Methods:
We analysed nationwide Swedish data from national databases and healthcare registers, identifying laboratory-confirmed COVID-19 cases from February 2020 to April 2021. Chronic HBV infection was classified into cases with and without cirrhosis. Multivariable logistic regression assessed the association between HBV and severe COVID-19, adjusting for demographics, comorbidities, vaccination, and socioeconomic factors.
Results:
Among 1,057,174 COVID-19 cases, 2,902 had chronic HBV infection, which was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR] 1.242, 95% confidence interval [CI] 1.097-1.403). This risk was significantly higher in HBV individuals with cirrhosis (aOR 2.463, CI 1.546-3.892) compared to those without cirrhosis (aOR 1.183, CI 1.039-1.343). While overall COVID-19 mortality was not significantly elevated in the HBV cohort, patients with cirrhosis showed a higher, though nonsignificant, mortality risk (aOR 2.350, CI 0.921-5.203).
Conclusion:
This nationwide study highlights an increased risk of severe COVID-19 in individuals with chronic HBV, particularly those with cirrhosis. Geographic and socioeconomic factors further influence outcomes. These findings underscore the need to consider HBV status in COVID-19 risk assessments. Future studies should explore these associations in the context of evolving SARS-CoV-2 variants and widespread vaccination.
