COVID-19 impacts HDV screening, patient outcomes

The COVID-19 pandemic has highlighted areas in which the medical community can improve patient care and access to treatment for numerous conditions, including hepatitis D virus.

It has also posed challenges to health care providers as they learn to care for patients with comorbid conditions who became infected with SARS-CoV-2.

Healio spoke with Nancy S. Reau, MD, FAASLD, AGAF, the Richard B. Capps Chair of Hepatology and professor of digestive diseases and nutrition at Rush University, to learn more about the pandemic’s impact on HDV screening, outcomes and more.

Patient outcomes

According to Reau, patients with viral hepatitis appeared to “do very well with COVID-19” infections. And even those with well compensated cirrhosis tend to have good outcomes.

“We don’t think that COVID-19 is significantly more dangerous for a person who has hepatitis unless they have very advanced liver disease,” she said.

Research published in 2022 reported that chronic liver disease — including nonalcoholic fatty liver disease, chronic viral hepatitis, alcoholic liver disease and autoimmune conditions — was significantly related to adverse outcomes in patients with COVID-19.

The systematic review and meta-analysis included 40 studies — primarily from the United States and China — with a total of 908,032 participants. However, a subgroup analysis revealed that patients with COVID-19 who had viral hepatitis were not at a significantly increased risk for severe COVID-19 (pooled OR = 1.29; 95% CI, 0.36-4.63).

COVID-19 vaccination, hesitancy

Reau noted that liver transplant patients and other immunocompromised individuals face additional risks from COVID-19 infection.

She explained that vaccine efficacy is lower among transplant patients, and therefore, they require additional booster doses.

As of October 2022, the CDC recommends that severely immunocompromised adults — including transplant patients — receive COVID-19 vaccine doses in the primary series followed by an updated bivalent booster at least two months after last booster.

According to Reau, vaccine hesitancy varies among patients, and while some were eager to receive their first dose once it because available, some were not.

“Other individuals, despite being very high risk [with] combinations of advanced liver disease or comorbid conditions in an area where social distancing was not particularly embraced, [had] extreme vaccine hesitancy or maybe not even vaccine hesitancy — vaccine hatred.”

Reau stressed the importance of working with these patients to address COVID-19 vaccination concerns.

Screening for HDV, HBV

While hepatitis screening was significantly affected by the COVID-19 pandemic, Reau told Healio that it was already low in some areas before the pandemic.

She noted that while physicians who practice in areas where HDV is more common are accustomed to ordering HDV testing, this may not be part of the “practice pattern” for physicians in areas with low rates of HDV.

Additionally, some health care providers may hesitate because of the high cost of the test for HDV or even the inability to have access to testing.

Reau emphasized that HDV “is a vaccine preventable disease,” and it is important to screen patients with HBV to identify those at risk for disease progression.

“There are very few things that we can identify and cure or control, and as hepatitis B drug development progresses toward functional or sterilizing cure in the future, most of our young patients with hepatitis B will have a curative option in their lifetime, but we have to find them,” Reau said. “We have to find them before they have advanced disease. Equally important is to vaccinate those that do not have protection from hepatitis B. If you prevent hepatitis B, you also prevent hepatitis delta.”

References:

CDC. COVID-19 vaccines for people who are moderately or severely immunocompromised. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html. Accessed Oct. 20, 2022.

Nagarajan R, et al. Prev Chronic Dis. 2022;doi: 10.5888/pcd19.210228.