Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners

Table 8 Expert guidance for management of autoimmune liver disease during coronavirus disease 2019 pandemic[168]

	Selected recommendations from EASL, AASLD for management of auto-immune hepatitis
	(1) In-person visits should be minimized as much as possible. Switch to virtual platforms whenever possible; and (2) COVID-19 testing is recommended in cases of acute decompensation and liver failure.
Low risk of complications (stable patient on chronic immunosuppressive treatment)	(1) Frequent patient-provider communications for close monitoring; (2) Use of virtual platforms should be preferred whenever possible; and (3) Ensure adequate drug supply and refills to reduce running out of medications.
Moderate risk of complications (symptomatic disease in the absence of cirrhosis, compensated cirrhosis)	(1) Can empirically treat via virtual healthcare platform whenever possible; and (2) Avoiding liver biopsy whenever possible is also recommended.
High risk of complications (acute flare, decompensated cirrhosis)	(1) Minimize invasive procedures wherever possible; (2) In COVID-19 patients, dose reduction of antimetabolites is recommended if lymphopenia develops; and (3) In case of infection corticosteroids should be tapered as quickly as possible.

EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases; COVID-19: Coronavirus disease 2019.