Chronic liver diseases have become highly prevalent, particularly in developing countries. The rapid extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) causes infection of many patients with existing chronic liver diseases. The management of novel COVID-19 in view of chronic liver disease is largely dependent on the experience of the treating physician and the available data. 

The present study summarized the evidence about the management of liver disease patients, infected with COVID-19 infection, which can increase the severity of viral hepatitis B. in addition, its clearance in HBV patients is delayed. The severity of COVID-19 is increased by sixfold in obese patients with metabolic associated fatty liver disease (MAFDL). It is not recommended to reduce the dose of immunosuppressive therapy (as long as they are not infected with COVID-19) in patients with autoimmune liver disease (AILD), so as to avoid a flare of liver disease. However, immunosuppressant drugs should be altered, in the case of infection with COVID-19. 

No data is available that can suggest an increased risk or severity in metabolic liver diseases, such as hemochromatosis, Wilson’s disease, or alpha-1 antitrypsin deficiency. Patients with liver cirrhosis should be judiciously managed with slightest exposure to healthcare facilities. Basic investigations for follow-up can be scheduled at broader intervals. Admission should be done in COVID-19-clean areas, if needed. Some early reports demonstrates that patients with hepatocellular carcinomas may have poor prognosis. The patients with liver transplant recipients on immunosuppression therapy, coinfected with COVID-19 have a benign course, according to few reports in children and adults. The hepatotoxicity of COVID-19 drugs ranges from increase in mild liver enzyme to a flare of underlying liver diseases.

Hence, the decision to treat patients with specific liver disease infected with COVID-19  should be customized. It is advisable to use telemedicine, which can limit the exposure of healthcare workers and patients to infection with COVID-19 and decrease the use of personal protective equipment.

Source: Zaky S, Alboraie M, El Badry M, et al. Management of liver disease patients in different clinical situations during COVID-19 pandemic. Egyptian Liver Journal. 2021;11(1):21.