Epidemiological and Clinical Characteristics of 70 Cases of Coronavirus Disease and Concomitant Hepatitis B Virus Infection

A Multicentre Descriptive Study

Jian Wu; Jiong Yu; Xiaowei Shi; Wei Li; Shu Song; Liangping Zhao; Xinguo Zhao; Jun Liu; Dawei Wang; Chengyuan Liu; Biao Huang; Yiling Meng; Bin Jiang; Yijun Deng; Hongcui Cao; Lanjuan Li


J Viral Hepat. 2020;28(1):80-88. 

In This Article


Since December 2019, a novel coronavirus pneumonia, which has been named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been reported in Wuhan, China.[1,2] With the spread of the epidemic, most cities in China and other countries and regions have been affected.[3] SARS-CoV-2 is a positive-sense single-stranded RNA virus belonging to the genus Betacoronavirus.[4,5] Although the virus is similar to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), current evidence shows that SARS-CoV-2 is more infectious than the aforementioned viruses and is primarily transmitted through droplets or direct contact between individuals.[4,6] The average incubation period of SARS-CoV-2 infection is estimated to be longer (6.4 days), and the basic reproductive period of the virus is 2.24 - 3.58 days.[7] In patients with coronavirus disease (COVID-19), fever is the most common symptom, followed by cough.[8] Although, the epidemic situation in China has been effectively controlled, a larger-scale spread in countries and regions outside China is currently being observed.[9,10] As of 17 August 2020, more than 6,500,000 cases have been confirmed worldwide, with a total of 769,191 deaths.

Since the outbreak, the association between COVID-19 and liver injury has been concerning.[11] Several studies indicated that SARS-CoV-2, SARS-CoV and MERS-CoV can cause liver diseases.[12–14] Huang et al[15] analysed 41 cases of COVID-19, which showed an increased level of aspartate transaminase in 15 cases (37%), with the change being more obvious in severe cases. Mansoor et al[16] analysed the existing data on COVID-19 supporting high levels of abnormal transaminase and found that these studies actually proved that clinically significant liver injury is rare. A pathological analysis performed by Wang et al[17] showed that postmortem biopsy of the liver of patients with COVID-19 only showed slight steatosis, which is a common finding in sepsis; the authors failed to find viral inclusions in the liver. Currently, two aspects are considered to contribute to liver injury in COVID-19.[18] First, the expression of the COVID-19 receptor, angiotensin I-converting enzyme 2 (ACE2), which exists in the bile duct endothelial cells of liver tissue; it is speculated that COVID-19 can infect the bile duct endothelial cells of the liver and cause hepatic inflammatory injury. Second, hepatic injury can also be caused by drugs administered during the treatment of the disease.

Chronic liver disease affects approximately 90 million people in China.[19] However, the interaction between existing chronic liver disease caused by hepatitis B virus (HBV) infection and COVID-19 has not yet been studied. In patients with chronic liver disease and cirrhosis, clinicians should not underestimate their risk of poor outcomes after being infected with SARS-CoV-2. Compared to other patients with COVID-19, patients with combined SARS-CoV-2 and HBV infection have poor immune function, with a worse outcome of acute respiratory distress syndrome (ARDS).[20]

In this study, we reported the epidemiology, clinical characteristics, treatment, and outcome of 70 cases of combined SARS-CoV-2 and HBV infection, and analysed the risk factors for delayed recovery of these patients from COVID-19. We believe that our findings will be helpful for clinical management and treatment of COVID-19 patients with concomitant HBV infection.