The ongoing coronavirus disease-2019 (COVID-19) pandemic has warranted special considerations in the management of diseases. The study reviewed pre-existing diseases or treatment for it predisposes to, alters course of, and changes the management of COVID-19. Autoimmune hepatitis (AIH), an autoimmune disease requiring treatment with immunosuppressive drugs, which has the potential for varying degrees of underlying fibrosis. The use of immunosuppressive drugs could change the risk of acquiring COVID-19, the clinical course and severity of COVID-19 and the degree of underlying liver fibrosis could modify the clinical outcomes of patients with COVID-19. The current review summarized key areas relevant in elucidating and enhancing the clinical care of patients with AIH in the current pandemic.

Evidences suggest that the presence of pre-existing liver disease influence the outcomes of patients with COVID-19. Reports suggest that present pandemic will persists for a longer period, thus, it appear wise that the patients not having active COVID-19 but requiring induction or maintenance therapy for AIH should be given immunosuppression as needed as withdrawing, delaying or denying of therapy may cause worsening fibrosis or cirrhosis. Recommendations by APASL and the EASL also recommends that immunosuppression needs to be continued.

The management of AIH in COVID-19-positive patients warrants decision making dependent on a multidisciplinary, case-by-case basis. These decisions should be based on various factors, such as promptness to treat AIH, severity of COVID-19, presence of co-existing sepsis, requirement of drugs for COVID-19 that may have interactions with drugs given for AIH, etc. APASL recommends continuation of immunosuppression therapy in patients with mild COVID-19. This has been validated from studies that revealed withdrawing of immunosuppression in patients with AIH and active COVID-19 did not show any beneficial effect. However, another study showed that continuation of immunosuppression reduced the risk of new-onset liver injury.

Drug interactions are chiefly crucial while managing patients with COVID-19 and AIH. Owing to novel nature of COVID-19, the management strategies are constantly being revised with a variety of drugs being tried for its treatment, with varying effectiveness. The emergence of new reports every day and with the introduction of new drugs, it is important to be aware of the side effects of the drugs and their potential interaction with the other medications being used for the management of comorbid conditions.

Source: Journal of Clinical and Translational Hepatology. 2021. Available at: https://www.xiahepublishing.com/2310-8819/JCTH-2021-00001