Mortality Is not Increased in SARS-CoV-2 Infected Persons With Hepatitis C Virus Infection

Adeel A. Butt; Peng Yan; Rashid A. Chotani; Obaid S. Shaikh


Liver International. 2021;41(8):1824-1831. 

In This Article

Abstract and Introduction


Background: Impact of SARS-CoV-2 infection upon hospitalization, intensive care unit (ICU) admissions and mortality in persons with hepatitis C virus (HCV) infection is unknown.

Methods: We used the Electronically Retrieved Cohort of HCV infected Veterans (ERCHIVES) database to determine the impact of HCV infection upon the rates of acute care hospitalization, ICU admission and all-cause mortality. We identified Veterans with chronic HCV infection and propensity score matched controls without HCV in ERCHIVES. We excluded those with HIV or hepatitis B virus coinfection.

Results: We identified 975 HCV+ and 975 propensity score matched HCV− persons with SARS-CoV-2 infection. Mean FIB-4 score (±SD) was higher in those with HCV (1.9 ± 2.1 vs 1.2 ± 0.9; P < .0001) and a larger proportion of those with HCV had cirrhosis (8.1% vs 1.4%; P < .0001). A larger proportion of HCV+ were hospitalized compared to HCV- (24.0% vs 18.3%; P = .002); however, those requiring ICU care and mortality were also similar in both groups (6.6% vs 6.5%; P = .9). Among those with FIB-4 score of 1.45–3.25, hospitalization rate/1000-person-years was 41.4 among HCV+ and 20.2 among HCV−, while among those with a FIB-4 > 3.25, the rate- was 9.4 and 0.6 (P < .0001). There was no difference in all-cause mortality by age, gender, FIB-4 score, number of comorbidities or treatment with remdesivir and/or systemic corticosteroids.

Conclusions: HCV+ persons with SARS-CoV-2 infection are more likely to be admitted to a hospital. The hospitalization rate also increased with higher FIB-4 score. However, admission to an ICU and mortality are not different between those with and without HCV infection.


The SARS-CoV-2 pandemic has affected nearly every country and territory in the world. The primary target organ for SARS-CoV-2 infection is the respiratory system. However, short- and long-term effects on multiple other organ systems have now been well documented, including effects on cardiovascular,[1] renal,[2] gastrointestinal,[3] hepatic,[3,4] endocrine[5] and neurologic systems.[6,7] Gastrointestinal symptoms have been described in up to 15% of patients and abnormal liver enzymes in up to 36% of the hospitalized patients.[8,9] Conversely, patients with pre-existing cirrhosis are at a higher risk of liver function deterioration and higher mortality.[10] The effect of hepatitis C virus (HCV) infection upon the severity of SARS-CoV-2 infection is not known. We recently demonstrated that persons with HCV are infrequently tested for SARS-CoV-2 infection with a positivity rate of 6.2% among those who were tested.[11] Several reports have suggested that newer antiviral agents for HCV may also be effective against SARS-CoV-2.[12,13] However, no clinical studies have assessed the impact of HCV upon severity of SARS-CoV-2 illness, rate of hospitalization and mortality compared with an appropriately matched population without HCV infection. We sought to determine these outcomes in a population of Veterans with HCV infection and propensity score matched controls without HCV infection.