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Benign course of hepatitis A and COVID-19 coinfection: A retrospective observational case series with comparative
Georges Khalil1,2, Alexia Khoury3, Marina Antoinette Khalil4
1Medical Microbiology Department, Faculty of Medicine, Saint Joseph University, Beirut Lebanon, Campus des sciences médicales, Rue de Damas, B.P. 11-5076 - Riad El Solh, Beyrouth 1107 2180, Lebanon.
Insights
Hepatitis A virus (HAV) and COVID-19 coinfection did not worsen liver injury or recovery in healthy patients. However, screening for coinfection is advised, especially in endemic areas, due to potential risks.
Area of Science:
- Hepatology
- Infectious Diseases
- Viral Hepatitis
Background:
- The COVID-19 pandemic presents challenges in hepatitis A virus (HAV) endemic regions.
- Liver involvement in SARS-CoV-2 is known, but HAV-COVID-19 coinfection effects are unclear.
Purpose of the Study:
- To evaluate if COVID-19 coinfection exacerbates clinical outcomes or liver injury in patients with HAV infection.
Main Methods:
- Retrospective observational study of 15 patients with HAV infection.
- Comparison between 7 patients with HAV-COVID coinfection and 8 with HAV alone.
- Assessment of clinical data, liver function, and inflammatory markers.
Main Results:
- All patients had mild disease without hepatic complications or ICU admission.
- C-reactive protein (CRP) levels were higher in the coinfected group.
- No significant differences in liver enzymes or recovery rates were observed between groups.
Conclusions:
- HAV-COVID-19 coinfection in healthy individuals does not appear to worsen liver injury or delay recovery.
- Clinicians should screen for coinfection in patients with liver injury during COVID-19, particularly in HAV-endemic areas.
- Larger studies are needed to confirm findings and identify risk modifiers.
Background:
In regions where hepatitis A virus (HAV) is endemic, the COVID-19 pandemic has introduced new challenges. While liver involvement in SARS-CoV-2 is well documented, the impact of HAV-COVID-19 coinfection remains unclear.
Objective:
Evaluate whether COVID-19 coinfection worsens clinical outcomes or liver injury in patients with HAV infection.
Methods:
We conducted a retrospective observational study at a tertiary care hospital in Lebanon, including 15 patients with confirmed HAV infection: 7 individuals were infected with COVID-19 (HAV-COVID coinfection group) and 8 with HAV alone (HAV-only group). Clinical characteristics, liver function tests, inflammatory markers, and recovery trends were assessed at admission (Day 1) and follow-up (Day 10) and remote follow-up extended up to 30 days. Group comparisons were made using Mann-Whitney U tests with effect sizes reported as rank-biserial correlations.
Results:
All patients experienced a mild disease course without hepatic complications or ICU admissions. CRP levels were significantly higher in the HAV-COVID group at both time points (Day 1 p = 0.04; Day 10 p < 0.001), but no statistically significant differences were seen in liver enzymes or recovery rates between the groups.
Conclusion:
HAV-COVID-19 coinfection in otherwise healthy individuals does not appear to worsen liver injury or delay recovery compared to HAV alone. However, given isolated reports of fulminant hepatitis, clinicians should continue to screen for coinfection in patients presenting with liver injury during with COVID-19, especially in HAV-endemic regions. Larger studies are needed to confirm these findings and explore potential risk modifiers.
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