Study: COVID-19, Hepatitis B Co-Infection Presents Greater Risk of Abnormal Liver Function

Investigators find that individuals with both conditions are more likely to develop severe disease than those in the control group.

Individuals with both COVID-19 and the hepatitis B virus (HBV) are at greater risk of various liver disease and should receive more attentive care during treatment, according to results of a meta-analysis published in Digestive Diseases and Sciences.

There are 2 main causes of issues related to liver function in patients with COVID-19, including the infection acting directly on the liver, with liver biopsy specimens demonstrating moderate microvascular steatosis with mild lobular and portal vein activity, the study results showed.

Additionally, antibiotics and antivirals, which can be used to treat COVID-19, can be toxic to the liver and may cause abnormal liver function.

For those with HBV, it is unclear whether a COVID-19 infection could increase the severity or increase the inflammatory response of the liver.

Investigators searched various databases, including Embase, PubMed, and Web of Science, and divided 37,696 individuals into 2 groups: those with COVID-19 and HBV and those who were diagnosed with COVID-19 without HBV.

The 2591 individuals with COVID-19 and HBV had higher in-hospital mortality rates than the 35,105 in the control group, who only had COVID-19.

Additionally, the investigators found that individuals with both COVID-19 and HBV were more likely to develop severe disease than those in the control group. These individuals also had significantly higher levels of alanine aminotransferase, aspartate aminotransferase (AST), direct bilirubin, lactate dehydrogenase, and total bilirubin (TB), than those with just COVID-19.

There were no significant differences between the 2 groups in terms of albumin, alkaline phosphate, creatine kinase, gamma-glutamyl transferase , and globulin levels and activated partial thromboplastin and , prothrombin time.

The investigators used the Egger’s test to analyze the publication bias. They found a bias on COVID-19 and HBV on AST and TB, but no other results showed a significant bias.

Investigators concluded that some liver function incidences were higher in individuals with both COVID-19 and HBV, which suggested that more severe liver function abnormalities could be present. They found in 1 study that individuals with elevated AST had a 10.2-year shorter life expectancy for all-cause and liver-related mortality.

After analyzing 2932 studies, investigators included 13 in the meta-analysis. They excluded articles based on duplicate studies, insufficient data, overlapping patients, relevancy to the meta-analysis, and other criteria.

The studies included individuals from 4 regions: mainland China, Hong Kong, Korea, and Turkey.

A limitation of the study included the regions that were included, because there is a high prevalence of HBV infection in China, so the population is limited, investigators said.

For the study results to be applied globally, there must be more global data to verify the findings, they concluded.

Additionally, the difference in liver function of individuals with COVID-19 with and without HPV infection only suggests abnormal liver functions but not liver injury.


Yu Y, Li X, Wan T. Effects of hepatitis B virus infection on patients with COVID-19: a meta-analysis. Dig Dis Sci. 2022;1-17 doi:10.1007/s10620-022-07687-2