Rates and Characteristics of SARS-CoV-2 Infection in Persons With Hepatitis C Virus Infection

Adeel A. Butt; Peng Yan


Liver International. 2021;41(1):76-80. 

In This Article

Abstract and Introduction


Background: Rate of SARS-CoV-2 infection and impact of liver fibrosis stage upon infection rates in persons with hepatitis C virus (HCV) infection are unknown.

Methods: We retrospectively analysed the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a well-established database of HCV-infected Veterans in care. We excluded those with missing FIB-4 score and those with HIV or hepatitis B virus co-infection. We determined the number of persons tested, proportion who tested positive for SARS-CoV-2 and the infection rate by age and liver fibrosis stage.

Results: Among 172,235 persons with HCV, 14,305 (8.3%) were tested for SARS-CoV-2 infection and 892 (6.2%) tested positive. Those with SARS-CoV-2 infection were older, more likely to be Black (55.2% vs 37.8%), obese (body mass index >30 kg/m2 36.2% vs 29.7%) and have diabetes or stroke (P < .0001 for all comparisons). Mean FIB-4 scores and proportion of persons with cirrhosis (based on a FIB-4 > 3.25) were similar in both groups. Incidence rate/1,000 tested persons was much higher among Blacks (88.4; 95% CI 81.1, 96.2) vs Whites (37.5; 95% CI 33.1, 42.4) but similar among those with cirrhosis (FIB-4 > 3.25). The rates were also similar among those who were untreated for HCV vs those treated with or without attaining a sustained virologic response.

Conclusions: Testing rates among persons with HCV are very low. Persons with infection are more likely to be Black, have a higher body mass index and diabetes or stroke. The degree of liver fibrosis does not appear to have an impact on infection rate.


As of 9 August 2020, >20 million persons have been infected and over 730 000 have died of SARS-CoV-2 infection worldwide. While infection rates appear to have diminished significantly in some countries, the pandemic rages on in others, particularly in the Americas. While primarily a respiratory illness, SARS-CoV-2 may affect multiple organ systems. Effects on cardiovascular,[1] renal,[2] gastrointestinal,[3] hepatic,[3,4] endocrine[5] and neurologic systems have been reported. Gastrointestinal symptoms may be present in up to 15% of patients and abnormal liver enzymes in up to 36% of the hospitalized patients.[6,7] The incidence of SARS-CoV-2 infection among persons with hepatitis C virus (HCV) infection, and its association with degree of liver fibrosis are unknown. Whether persons with HCV experience more severe disease or higher mortality is also unknown. We undertook this study to determine the infection rate and clinical characteristics of SARS-CoV-2 infection among persons with HCV infection.