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©The Author(s) 2021.
World J Gastroenterol. Apr 7, 2021; 27(13): 1296-1310
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1296
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1296
Hospitalization and severe COVID-19 | Alterations to standard treatment strategies | Progression of liver disease | ||
Early administration, laboratory findings and risk of SARS-CoV-2 infection | Treatment of higher risk groups | Resumption of targeted treatment and surveillance | Patient education and intensive lifestyle advice | |
NAFLD | High prevalence risk of SARS-CoV-2 infection in NAFLD patients with COVID-19 suggest an early admission to the hospital | No side effects related to ACE inhibitors or AR blockers to date, thus, arterial hypertension treatment should continue in accordance to prescribed guidelines | Not well known | Intensive lifestyle interventions including nutritional guidance, weight loss and diabetes management may prevent the risk of severe COVID-19 complications |
Chronic Viral Hepatitis | Patients on chronic HBV or HCV medications with poor compliance should observed treatment protocols, directly | (1) In HBV and COVID-19 patients, an alternative agent should be considered rather than interferon-α therapy; (2) COVID-19 patients with high risk of severe acute HCV should consider for an appropriate antiviral therapy on case-by-case basis under the full consultation; and (3) COVID-19 patients with resolved HBV infection, receiving corticosteroids, tocilizumab, or other immunosuppressant agents should be considered for appropriate antiviral therapy to prevent viral reactivation under full consultation | (1) Without COVID-19, the patients should continue the HBV or HCV medications in accordance to general guidelines; and (2) in COVID-19 patients, initiation of HBV or HCV medication should be deferred until full recovery from COVID-19 or on case-by-case basis under the full consultation | Use of telemedicine for patients of on-going chronic HBV or HCV treatment without COVID-19 |
Autoimmune hepatitis | (1) Immunocompromised patients on corticosteroid treatment during COVID-19 requires respiratory support; And (2) patients on respiratory support may be considered for addition of, or conversion to, dexamethasone treatment | (1) Patients on high doses of corticosteroid may show more susceptibility to SARS-CoV-2 infection or severe COVID-19; (2) Low doses may be considered under special circumstances (e.g., drug-induced lymphopenia, or bacterial/fungal superinfection with severe COVID-19) under consultation with specialist; (3) or may consider budesonide as an alternative first line agent in patient without cirrhosis to induce remission who have a flare of autoimmune hepatitis | Immunocompromised patients with COVID-19 may be considered for dosing of corticosteroid, sufficient for adrenal insufficiency | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
Alcohol-related liver hepatitis | Alcohol-induced severe hepatitis patients on corticosteroid treatment with COVID-19 require respiratory support | Not well known | Not well known | Increased probability of higher alcohol consumption during social distancing, so, preemptive strategies including patient outreach and telephone alcohol liaison, should be considered |
Cirrhosis | (1) Cirrhotic patients with COVID-19 should be considered for early hospitalization; and (2) to avoid admission and to prevent decompensation, guidelines on prophylaxis of spontaneous bacterial peritonitis, gastrointestinal hemorrhage and hepatic encephalopathy should be followed | Vasoconstriction therapy should be considered with great caution for critically ill cirrhotic patients with COVID-19 | Cirrhotic patients are vulnerable to both SARS-CoV-2 infection and altered standards of patient care during pandemic. Thus, the best efforts should be made for care of cirrhotic patients according to general guidelines | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
Hepatocellular carcinoma | Specific risk of HCC patients with COVID-19 remains undefined | In COVID-19 patients, initiation of HBV or HCV medication should be deferred until full recovery from COVID-19 or on case-by-case basis under the full consultation | Full HCC surveillance should resume under specific circumstances | Consider virtual patient visits to discuss diagnosis and management of HCC and other liver tumors |
Liver transplant candidates | Patients on the liver transplant waiting list with decompensated cirrhosis are at high risk of severe COVID-19 and death following SARS-CoV-2 infection | Precautions should be followed to make COVID-19 free liver transplantation process | Not well known | Patients should avoid attending in-person community recovery support meetings, such as Alcoholics Anonymous, and provide alternative telephone or online resources |
Liver transplant recipients | Early admission should be considered for all liver transplant recipients who develop COVID-19 | Drug levels of calcineurin inhibitors and mechanistic target of rapamycin inhibitors should be closely monitored on administration with COVID-19 medications, particularly hydroxychloroquine, protease inhibitors or new trial drugs for COVID-19 | Reduction of immunosuppressant dosing may be considered under special circumstances (e.g., drug-induced lymphopenia, or bacterial/fungal superinfection with severe COVID-19) under consultation with specialist | All patients should receive vaccination of Streptococcus pneumoniae and influenza |
- Citation: Ahmad A, Ishtiaq SM, Khan JA, Aslam R, Ali S, Arshad MI. COVID-19 and comorbidities of hepatic diseases in a global perspective. World J Gastroenterol 2021; 27(13): 1296-1310
- URL: https://www.wjgnet.com/1007-9327/full/v27/i13/1296.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i13.1296