The existing health crisis caused by SARS-CoV-2 and its fatal consequences, of the cytokine storm associated with it have led to implementation of therapies with the main motive of ceasing the hyperactivation of the immune system. Out of these therapies, corticosteroids have become mainstay treatment in cases where clinical and analytical progress is unfavorable.

However, corticosteroids exhibits certain risks including reactivation of previously-acquired infectious and ideally, their use should be prevented.  A recent study have shown that chronic HBV infection has been associated with slowed clearance of SARS-CoV-2.

The current study reviewed the latest recommendations on management of patients who are eligible for receiving corticosteroids at high doses or in pulses for the treatment of SARS-CoV-2.

The EASL and the American Gastroenterological Association (AGA) recommends HBV screening through evaluation of HBsAg and anti-HBc for all patients who are going to receive immunosuppressive treatment. While, AEMPS guidelines from July 2014 in patients with HBsAg⁺ and a viral load greater than or equal to 2000 U/mL, suggests that treatment must be started with entecavir or tenofovir. However, if the viral load is less than 2000 U/mL and immunosuppressive treatment needs to be used for a short period, universal prophylaxis with lamivudine should be used. On the contrary, in case of a patient with HBsAg⁻, anti-HBc⁺, and a detectable viral load, the same indication as for HBsAg⁺ patients should be adopted

Thus, it concluded that systemic corticosteroids are one of the treatment of choice in regard to COVID-19 pandemic. A HBV screening should be conducted through assessment of HBsAg and anti-HBc in all patients for whom they are indicated.

Source: Rev Clin Esp (Barc). 2020;220(8):535-536.