Systematic Reviews
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World J Gastroenterol. Dec 14, 2022; 28(46): 6599-6618
Published online Dec 14, 2022. doi: 10.3748/wjg.v28.i46.6599
Correlation between COVID-19 and hepatitis B: A systematic review
Yan-Fei He, Zhi-Gang Jiang, Ni Wu, Ning Bian, Jun-Lin Ren
Yan-Fei He, Ni Wu, Ning Bian, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Zhi-Gang Jiang, Department of Statistics, Zunyi Medical University, Guizhou 563006, Guizhou Province, China
Jun-Lin Ren, Department of Infection Control, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Author contributions: He YF designed the study, reviewed the literature, and drafted the manuscript; Jiang ZG and Wu N retrieved and summarized the literature; Ren JL and Bian N advised on the review and reviewed the final manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Fei He, MD, Associate Chief Physician, Doctor, Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China. heyanfeilc@163.com
Received: September 11, 2022
Peer-review started: September 11, 2022
First decision: October 19, 2022
Revised: October 29, 2022
Accepted: November 19, 2022
Article in press: November 19, 2022
Published online: December 14, 2022
Processing time: 88 Days and 3.8 Hours
Abstract
BACKGROUND

There is growing evidence that patients with coronavirus disease 2019 (COVID-19) frequently present with liver impairment. Hepatitis B virus (HBV) remains a major public health threat in current society. Both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HBV can cause liver damage, and current findings on whether HBV infection increases disease severity in COVID-19 patients are inconsistent, and whether SARS-CoV-2 infection accelerates hepatitis B progression or leads to a worse prognosis in hepatitis B patients has not been adequately elucidated.

AIM

To explore the complex relationship between COVID-19 and hepatitis B in order to inform the research and management of patients co-infected with SARS-CoV-2 and HBV.

METHODS

An experienced information specialist searched the literature in the following online databases: PubMed, China National Knowledge Infrastructure, Google Scholar, Scopus, Wiley, Web of Science, Cochrane, and ScienceDirect. The literature published from December 2019 to September 1, 2022 was included in the search. We also searched medRxiv and bioRxiv for gray literature and manually scanned references of included articles. Articles reporting studies conducted in humans discussing hepatitis B and COVID-19 were included. We excluded duplicate publications. News reports, reports, and other gray literature were included if they contained quantifiable evidence (case reports, findings, and qualitative analysis). Some topics that included HBV or COVID-19 samples but did not have quantitative evidence were excluded from the review.

RESULTS

A total of 57 studies were eligible and included in this review. They were from 11 countries, of which 33 (57.9%) were from China. Forty-two of the 57 studies reported abnormalities in liver enzymes, three mainly reported abnormalities in blood parameters, four indicated no significant liver function alterations, and another eight studies did not provide data on changes in liver function. Fifty-seven studies were retrospective and the total number of co-infections was 1932, the largest sample size was 7723, and the largest number of co-infections was 353. Most of the studies suggested an interaction between hepatitis B and COVID-19, while 12 studies clearly indicated no interaction between hepatitis B and COVID-19. Six of the 57 studies clearly reported HBV activation. Six studies were related to liver transplant patients.

CONCLUSION

There is some association between COVID-19 and hepatitis B. Future high-quality randomized trials are needed to further elucidate the interaction between COVID-19 and hepatitis B.

Keywords: COVID-19; SARS-CoV-2; Hepatitis B virus; Chronic hepatitis B; Liver injury; Co-infection

Core Tip: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hepatitis B virus (HBV) infections are two major current global public health crises. Both infection with SARS-CoV-2 and infection with HBV can cause liver damage. There are conflicting views on whether HBV infection aggravates the prognosis of patients with coronavirus disease 2019 (COVID-19). There is a potential association between COVID-19 and hepatitis B. Clarification of this association could benefit these special patients with SARS-CoV-2 and HBV co-infection.