Risk of hepatitis B reactivation in COVID-19 patients receiving corticosteroid therapy: A retrospective cohort study

COVID-19 and HBV are significant public health issues, and managing their co-infection remains unclear. Corticosteroid therapy improves survival in severe COVID-19 but may increase the risk of HBV reactivation (HBVr). Evidence regarding the incidence and outcomes of HBVr in COVID-19 patients remains limited. This study aimed to investigate the frequency, determinants, and clinical consequences of HBVr among COVID-19 patients with current or past HBV infection treated with corticosteroids. This retrospective study evaluated adult patients with COVID-19 and evidence of HBV infection hospitalized between March 2020 and January 2022 at a tertiary center, where 13,673 individuals were screened during the study period. Demographics, corticosteroid use, laboratory findings, HBV DNA results, and outcomes were analyzed. HBVr was defined according to the criteria outlined in current international guidelines. Out of 13,673 hospitalized COVID-19 patients, 145 (125 HBsAg-positive and 20;anti-HBcIgG-positive) were identified as having HBV exposure. Corticosteroids were administered to 75 patients (51.7%) with a median cumulative dose of 520 (240-1400) mg and duration of 6 (4-10) days. HBVr occurred in 7 patients, all HBsAg-positive; 2 developed hepatic failure and died. Patients with HBVr had significantly higher cumulative corticosteroid doses (p=.021) and longer durations of therapy (p=.007) compared with those without reactivation. Five patients received nucleos(t)ide analogues with subsequent viral suppression. COVID-19 patients with chronic HBV infection, particularly those receiving corticosteroids, are at increased risk of HBVr and poor outcomes. Based on our findings, HBV screening and consideration of antiviral prophylaxis should be routine prior to corticosteroid therapy, particularly in regions with intermediate-to-high HBV prevalence, since HBVr may occur even with short-term corticosteroid exposure.