Persons with hepatitis C virus (HCV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were more likely to be admitted to a hospital compared with a well matched group without HCV infection, according to a study published in Liver International.
The hospitalisation rate also increased with higher fibrosis-4 (FIB-4) score. However, admission to an intensive care unit (ICU) and mortality were not different between those with and without HCV infection.
“To our knowledge, this is the first study specifically looking at the impact of HCV infection upon the risk of hospitalisation and all-cause mortality compared with a well-matched population without HCV infection, and to assess the impact of liver fibrosis stage upon these outcomes,” wrote Adeel A. Butt, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, and colleagues.
Using the Electronically Retrieved Cohort of HCV infected Veterans database, researchers identified 975 patients with HCV infection and SARS-CoV-2 infection and 975 propensity-score matched SARS-CoV-2-infected persons without HCV infection. Mean FIB-4 score was higher in those with HCV infection (1.9 vs 1.2; P <0.0001) and a larger proportion of those with HCV had cirrhosis (8.1% vs 1.4%; P <0.0001).
The researchers found that a larger proportion of patients with HCV infection were hospitalised compared to those without HCV infection (24.0% vs 18.3%; P = 0.002). However, the proportions of patients requiring ICU care (13.0% vs 12.5%; P = 0.73) and mortality were similar in both groups (6.6% vs 6.5%; P = 0.93).
“We carefully matched the groups for age, sex, race and multiple comorbidities. It is well documented that the prevalence of several medical, psychiatric and substance use disorders is different in those with HCV compared with those without HCV and comorbidities are associated with poorer outcomes in persons with SARS-CoV-2 infection,” the authors noted. “The apparent lack of difference in severity of disease (as measured by the need for ICU care) and mortality indicates that any possible differences in these outcomes in persons with and without HCV may be explained, at least in part, by the differential prevalence of these comorbidities.”
In addition, among those with FIB-4 score of 1.45-3.25, hospitalisation rate per 1,000-person-years was 41.4 among those with HCV and 20.2 among those without HCV, while among those with a FIB-4 score >3.25, the rate was 9.4 and 0.6, respectively (P <0.0001). Similarly, admission to ICU was more prevalent in persons with HCV among those with FIB-4 score of 1.45-3.25 and among those with FIB-4 score of >3.25.
“In subgroup comparisons, the only factor associated with a higher rate of hospitalisation or ICU admission in persons with HCV (compared to those without HCV) was more advanced liver fibrosis as measured by the non-invasive FIB-4 score,” the authors wrote. “When comparing those with and without HCV with similar FIB-4 score, the rates of hospitalisation and ICU admission were much higher in those with HCV. This indicates that any potential increased risk of adverse outcomes in persons with HCV is not dependent only on the degree of liver fibrosis. Whether the difference is due to viral or host factors is unknown.”
“More studies are needed to understand the true association between HCV and severity of SARS-CoV-2 illness,” the authors added.