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Elnaggar M, Abomhya A, Elkhattib I, Dawoud N, Doshi R. COVID-19 and liver diseases, what we know so far. World J Clin Cases 2022; 10:3969-3980. [PMID: 35665122 PMCID: PMC9131221 DOI: 10.12998/wjcc.v10.i13.3969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia outbreak started in December 2019. On March 12, 2020, the World Health Organization (WHO) declared that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a pandemic, and as of May 2021, SARS-CoV-2 has infected over 167.3 million patients, including 3.4 million deaths, reported to WHO. In this review, we will focus on the relationship between SARS-CoV-2 infection and the liver. We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes. We will also discuss the SARS-CoV-2 effects on the liver, mechanisms of acute liver injury, and potential management plans.
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Affiliation(s)
- Mohamed Elnaggar
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89052, United States
| | - Ahmed Abomhya
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11200, United States
| | - Ismail Elkhattib
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Nabila Dawoud
- Department of Internal Medicine, University of Kentucky, Lexington, KY 40508, United States
| | - Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ 07503, United States
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2
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Law MF, Ho R, Law KWT, Cheung CKM. Gastrointestinal and hepatic side effects of potential treatment for COVID-19 and vaccination in patients with chronic liver diseases. World J Hepatol 2021; 13:1850-1874. [PMID: 35069994 PMCID: PMC8727202 DOI: 10.4254/wjh.v13.i12.1850] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is a global pandemic. Many clinical trials have been performed to investigate potential treatments or vaccines for this disease to reduce the high morbidity and mortality. The drugs of higher interest include umifenovir, bromhexine, remdesivir, lopinavir/ritonavir, steroid, tocilizumab, interferon alpha or beta, ribavirin, fivapiravir, nitazoxanide, ivermectin, molnupiravir, hydroxychloroquine/chloroquine alone or in combination with azithromycin, and baricitinib. Gastrointestinal (GI) symptoms and liver dysfunction are frequently seen in patients with COVID-19, which can make it difficult to differentiate disease manifestations from treatment adverse effects. GI symptoms of COVID-19 include anorexia, dyspepsia, nausea, vomiting, diarrhea and abdominal pain. Liver injury can be a result of systemic inflammation or cytokine storm, or due to the adverse drug effects in patients who have been receiving different treatments. Regular monitoring of liver function should be performed. COVID-19 vaccines have been rapidly developed with different technologies including mRNA, viral vectors, inactivated viruses, recombinant DNA, protein subunits and live attenuated viruses. Patients with chronic liver disease or inflammatory bowel disease and liver transplant recipients are encouraged to receive vaccination as the benefits outweigh the risks. Vaccination against COVID-19 is also recommended to family members and healthcare professionals caring for these patients to reduce exposure to the severe acute respiratory syndrome coronavirus 2 virus.
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Affiliation(s)
- Man Fai Law
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Rita Ho
- Department of Medicine, North District Hospital, Hong Kong, China
| | | | - Carmen Ka Man Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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3
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Mnatsakanyan MG, Pogromov AP, Lishuta AS, Fomin VV, Volkova OS, Tashchyan OV, Kuprina IV, Shumskaya YF. Liver and COVID-19: possible mechanisms of damage. TERAPEVT ARKH 2021; 93:427-430. [DOI: 10.26442/00403660.2021.04.200733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023]
Abstract
The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.
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4
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Zaky S, Alboraie M, El Badry M, Metwally MA, Abdelaziz A, Fouad Y, Abd-Elsalam S, Mahmoud A, Shiha G, Baki AA, El Kassas M, Esmat G. Management of liver disease patients in different clinical situations during COVID-19 pandemic. EGYPTIAN LIVER JOURNAL 2021; 11:21. [PMID: 34777868 PMCID: PMC7994958 DOI: 10.1186/s43066-021-00091-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) leads to the infection of many patients with underlying chronic liver diseases. As a relatively new disease, management of COVID-19, in the context of chronic liver disease, is mainly based on the experience of the treating physician and the available data. In this review, we summarize the available evidence about the management of liver disease patients, in the context of COVID-19 infection, which can increase the severity of viral hepatitis B. Also, its clearance in HBV patients is delayed. A sixfold increased severity of COVID-19 was reported in obese patients with metabolic associated fatty liver disease (MAFDL). In patients with autoimmune liver disease (AILD), it is not recommended to change their immunosuppressive therapy (as long as they are not infected with COVID-19), in order to avoid a flare of liver disease. However, immunosuppressant drugs should be modified, in the case of infection with COVID-19. To date, no data 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 carefully managed with minimum exposure to healthcare facilities. Basic investigations for follow-up can be scheduled at wider intervals; if patients need admission, this should be in COVID-19-clean areas. Patients with hepatocellular carcinomas may have a poor prognosis according to preliminary reports from China. The course of COVID-19 in liver transplant recipients on immunosuppression seems to have a benign course, based on few reports in children and adults. The hepatotoxicity of COVID-19 drugs ranges from mild liver enzyme elevation to a flare of underlying liver diseases. Therefore, the decision should be customized. Telemedicine can minimize the exposure of healthcare workers and patients to infection with COVID-19 and decrease the consumption of personal protective equipment.
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Affiliation(s)
- Samy Zaky
- Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El Badry
- Endemic Medicine Department, Faculty of Medicine, Helwan University, 2-Ahmed Elzomor Street, Nasr City, Cairo Egypt
| | - Mohamed A. Metwally
- Hepatology, Gastroenterology and Infectious Diseases Department, Benha University, Benha, Egypt
| | - Ahmed Abdelaziz
- Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Demiatta, Egypt
| | - Yasser Fouad
- Tropical Medicine Department, Minia Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Abdelmajeed Mahmoud
- Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt
| | - Gamal Shiha
- Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amin Abdel Baki
- Department of Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, 2-Ahmed Elzomor Street, Nasr City, Cairo Egypt
| | - Gamal Esmat
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Hamid S, Alvares da Silva MR, Burak KW, Chen T, Drenth JP, Esmat G, Gaspar R, LaBrecque D, Lee A, Macedo G, McMahon B, Ning Q, Reau N, Sonderup M, van Leeuwen DJ, Armstrong D, Yurdaydin C. WGO Guidance for the Care of Patients With COVID-19 and Liver Disease. J Clin Gastroenterol 2021; 55:1-11. [PMID: 33230011 PMCID: PMC7713641 DOI: 10.1097/mcg.0000000000001459] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
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Affiliation(s)
- Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Kelly W. Burak
- Department of Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands
| | - Gamal Esmat
- Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Douglas LaBrecque
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alice Lee
- Hepatitis Program, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
| | - Mark Sonderup
- Department of Medicine, Division of Hepatology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dirk J. van Leeuwen
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Armstrong
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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6
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Téllez L, Martín Mateos RM. COVID-19 and liver disease: An update. GASTROENTEROLOGÍA Y HEPATOLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7546188 DOI: 10.1016/j.gastre.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The SARS-CoV-2 pandemic has proven to be a serious challenge for the Spanish healthcare system. The impact of the virus on the liver is not well known, but in patients with chronic liver disease, mostly in advanced stages, it can critically compromise survival and trigger decompensation. Treatment in this subpopulation is complex due to the potential hepatotoxicity of some of the medicinal products used. Moreover, the pandemic has also negatively impacted patients with liver disease who have not contracted COVID-19, since the reallocation of human and material resources to the care of patients with the virus has resulted in a decrease in the treatment, diagnosis and follow-up of patients with liver disease, which will surely have negative consequences in the near future. Efficient reorganisation of hepatology units is a priority to minimise the impact of the pandemic on a population as vulnerable as liver disease patients.
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7
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Sumida Y, Kimoto S, Sakamoto K, Ohashi T, Nakade Y, Itou K, Toyoda H, Tomita E, Kumada T, Yoneda M. Relationship between COVID-19 and liver diseases: the role of hepatologists in clinical practice. ACTA ACUST UNITED AC 2020. [DOI: 10.2957/kanzo.61.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshio Sumida
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | - Satoshi Kimoto
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | - Kazumasa Sakamoto
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | - Tomohiko Ohashi
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | - Yukiomi Nakade
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | - Kiyoaki Itou
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
| | | | | | - Takashi Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital
- Faculty of Nursing, Gifu Kyoritsu University
| | - Masashi Yoneda
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University
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8
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Téllez L, Martín Mateos RM. COVID-19 and liver disease: An update. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:472-480. [PMID: 32727662 PMCID: PMC7332955 DOI: 10.1016/j.gastrohep.2020.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 pandemic has proven to be a serious challenge for the Spanish healthcare system. The impact of the virus on the liver is not well known, but in patients with chronic liver disease, mostly in advanced stages, it can critically compromise survival and trigger decompensation. Treatment in this subpopulation is complex due to the potential hepatotoxicity of some of the medicinal products used. Moreover, the pandemic has also negatively impacted patients with liver disease who have not contracted COVID-19, since the reallocation of human and material resources to the care of patients with the virus has resulted in a decrease in the treatment, diagnosis and follow-up of patients with liver disease, which will surely have negative consequences in the near future. Efficient reorganization of hepatology units is a priority to minimise the impact of the pandemic on a population as vulnerable as liver disease patients.
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Affiliation(s)
- Luis Téllez
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Rosa María Martín Mateos
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
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9
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Rammohan A. Post-transplant immunosuppression and COVID-19: From a double whammy to a mixed blessing. World J Transplant 2020; 10:267-276. [PMID: 32995321 PMCID: PMC7504191 DOI: 10.5500/wjt.v10.i9.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 08/15/2020] [Indexed: 02/05/2023] Open
Abstract
The coronavirus pandemic (COVID-19) has had an unprecedented effect on various disease processes and their management. COVID-19 is likely to have a complex pathophysiological interplay with the post-transplant patients; one affecting the clinical course and outcome of the other. In the absence of validated data from trials, there is strong dependence on experience based on previous similar epidemics (SARS/MERS), and from consensus based on expert opinions. Despite the fact that our knowledge is rapidly evolving with time, there still is relatively limited objective data on the effect of COVID-19 on the human body. Numerous questions remain unanswered, one of which involves the management of immunosuppression in the post-transplant recipient during this contagion. The core tenet of which continues to be that of establishing an equipoise between infection and rejection. This review summarises the current knowledge on immune interactions of the virus, the immunomodulatory effects that may be at play, and its relation to the art of immunosuppression.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
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10
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Alqahtani SA, Aljumah AA, Hashim A, Alenazi TH, AlJawad M, Al Hamoudi WK, Alghamdi MY. Principles of Care for Patients with Liver Disease During the Coronavirus Disease 2019 (COVID-19) Pandemic: Position Statement of the Saudi Association for the Study of Liver Disease and Transplantation. Ann Saudi Med 2020; 40:273-280. [PMID: 32564624 PMCID: PMC7316371 DOI: 10.5144/0256-4947.2020.273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.
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MESH Headings
- Adenosine Monophosphate/adverse effects
- Adenosine Monophosphate/analogs & derivatives
- Adrenal Cortex Hormones/adverse effects
- Alanine/adverse effects
- Alanine/analogs & derivatives
- Amides/adverse effects
- Antiviral Agents/therapeutic use
- Azetidines/adverse effects
- Betacoronavirus
- Biopsy/methods
- COVID-19
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/therapy
- Comorbidity
- Coronavirus Infections/drug therapy
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Drug Combinations
- Drug Interactions
- Enzyme Inhibitors/adverse effects
- Hepatitis, Autoimmune/epidemiology
- Hepatitis, Autoimmune/therapy
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/therapy
- Humans
- Hydroxychloroquine/adverse effects
- Immunosuppressive Agents/therapeutic use
- Janus Kinase Inhibitors/adverse effects
- Liver Cirrhosis/epidemiology
- Liver Cirrhosis/therapy
- Liver Diseases/epidemiology
- Liver Diseases/therapy
- Liver Neoplasms/epidemiology
- Liver Neoplasms/therapy
- Liver Transplantation
- Lopinavir/adverse effects
- Non-alcoholic Fatty Liver Disease/epidemiology
- Non-alcoholic Fatty Liver Disease/therapy
- Pandemics/prevention & control
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Purines
- Pyrazines/adverse effects
- Pyrazoles
- Ritonavir/adverse effects
- SARS-CoV-2
- Saudi Arabia/epidemiology
- Sulfonamides/adverse effects
- Ultrasonography/methods
- COVID-19 Drug Treatment
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Affiliation(s)
- Saleh A. Alqahtani
- From the Liver Transplant Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- From the Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Almoutaz Hashim
- From the Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Thamer H. Alenazi
- From the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- From the Infectious Disease Division, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed AlJawad
- From the Multi-organ Transplant Center, King Fahad Specialist Hospital, Dammam. Saudi Arabia
| | | | - Mohammed Y. Alghamdi
- From the Department of Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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11
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Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease-what we know on 1st May 2020. Aliment Pharmacol Ther 2020; 52:267-275. [PMID: 32402090 PMCID: PMC7272838 DOI: 10.1111/apt.15813] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), became a global threat to human health. Liver impairment has been frequently reported as a common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver disease (CLD). AIMS To summarise the changes in liver function tests during SARS-CoV-2 infection and the impact of COVID-19 in patients with underlying CLD. METHODS A literature review using online database PubMed was done using the search terms "SARS-CoV-2", "COVID-19", "liver", "cirrhosis" and "liver transplantation". RESULTS COVID-19 is frequently associated with different degrees of abnormal liver function tests, most notably transaminases, which are usually transitory and of mild degree. Available evidence suggests that liver injury may result from direct pathogenic effect by the virus, systemic inflammation or toxicity from commonly used drugs in this subset of patients. SARS-CoV-2 infection in children is associated with minimal or no increase in liver enzymes, thus the presence of abnormal liver function tests should trigger evaluation for underlying liver diseases. Although it seems that patients with CLD are not at greater risk for acquiring the infection, those with cirrhosis, hepatocellular carcinoma, non-alcoholic fatty liver disease, autoimmune liver diseases or liver transplant may have a greater risk for severe COVID-19. CONCLUSIONS Abnormal liver function tests during the course of COVID-19 are common, though clinically significant liver injury is rare. Further research is needed focusing on the effect of existing liver-related comorbidities on treatment and outcome of COVID-19.
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Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology DepartmentCentro Hospitalar Sao JoaoPortoPortugal
- World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
| | - Rodrigo Liberal
- Gastroenterology and Hepatology DepartmentCentro Hospitalar Sao JoaoPortoPortugal
- World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology DepartmentCentro Hospitalar Sao JoaoPortoPortugal
- World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
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12
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Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Cornberg M, Berg T. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020; 2:100113. [PMID: 32289115 PMCID: PMC7128473 DOI: 10.1016/j.jhepr.2020.100113] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an enormous challenge to healthcare systems in affected communities. Older patients and those with pre-existing medical conditions have been identified as populations at risk of a severe disease course. It remains unclear at this point to what extent chronic liver diseases should be considered as risk factors, due to a shortage of appropriate studies. However, patients with advanced liver disease and those after liver transplantation represent vulnerable patient cohorts with an increased risk of infection and/or a severe course of COVID-19. In addition, the current pandemic requires unusual allocation of healthcare resources which may negatively impact the care of patients with chronic liver disease that continue to require medical attention. Thus, the challenge hepatologists are facing is to promote telemedicine in the outpatient setting, prioritise outpatient contacts, avoid nosocomial dissemination of the virus to patients and healthcare providers, and at the same time maintain standard care for patients who require immediate medical attention.
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Key Words
- ACE-I, angiotensin-converting enzyme inhibitor
- ACE2, angiotensin-converting enzyme 2
- ACLF, acute-on-chronic liver failure
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- COVID-19, coronavirus disease 2019
- EGD, esophagogastroduodenoscopy
- ERC, endoscopic retrograde cholangiography
- HCC, hepatocellular carcinoma
- MELD, model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NUC, nucleoside analogue
- PIs, protease inhibitors
- RdRp, RNA-dependent RNA polymerase
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- ULN, upper limit of normal
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Affiliation(s)
- Tobias Boettler
- Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip N. Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mario U. Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Elisa Cordero
- Department of Medicine, University of Seville, Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, Sevilla, CSIC, Spain
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Centre for Individualised Infection Medicine (CIIM), Hannover, Germany
| | - Thomas Berg
- Division of Hepatology, Clinic and Polyclinic for Gastroenterology, Hepatology, Infectious Diseases, and Pneumology, University Hospital Leipzig, Leipzig, Germany
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Schultheiß M, Kling S, Lenker U, von Bibra M, Rosenkranz B, Klinker H. Lopinavir serum concentrations of critically ill infants: a pharmacokinetic investigation in South Africa. Med Microbiol Immunol 2018; 207:339-343. [PMID: 29974233 DOI: 10.1007/s00430-018-0550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
The role of therapeutic drug monitoring in pediatric antiretroviral therapy is unclear. A little pharmacokinetic datum from clinical practice exists beyond controlled approval studies including clinically stable children. The aim of this study is to quantify LPV exposure of critically ill infants in an ICU and-by identifying risk factors for inadequate exposure-to define sensible indications for TDM in pediatric HIV care; in addition, assume total drug adherence in ICU to compare LPV exposure with a setting of unknown adherence. In this prospective investigation, 15 blood samples from critically ill infants in the pediatric ICU at Tygerberg Hospital were analyzed for LPV-serum concentrations. They were then compared to those of 22 blood samples from out-patient children. Serum-level measurements were performed with an established high-performance liquid chromatography method. All LPV-serum levels of ICU patients were higher than a recommended Ctrough (= 1.000 ng/ml), 60% of levels were higher than Cmax (8.200 ng/ml). Partly, serum levels reached were extremely high (Maximum: 28.778 ng/ml). Low bodyweight and age correlated significantly with high LPV concentrations and were risk factors for serum levels higher than Cmax. Significantly fewer serum levels from infants in ICU care (mean: 11.552 ng/ml ± SD 7760 ng/ml) than from out-patient children (mean: 6.756 ng/ml ± SD 6.003 ng/ml) were subtherapeutic (0 vs. 28%, p = 0.008). Under total adherence in the ICU group, there were no subtherapeutic serum levels, while, in out-patient, children with unknown adherence 28% of serum levels were found subtherapeutic. Low bodyweight and age are risk factors for reaching potentially toxic LPV levels in this extremely fragile population. TDM can be a reasonable tool to secure sufficient and safe drug exposure in pediatric cART.
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Affiliation(s)
- Michael Schultheiß
- Medizinische Klinik und Poliklinik II, Schwerpunkt Infektiologie, Universitätsklinikum Würzburg, ZIM Haus A3/A4, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Sharon Kling
- Department of Pediatrics and Child Health, Ward A9, Tygerberg Hospital, University of Stellenbosch, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Ulrike Lenker
- Medizinische Klinik und Poliklinik II, Schwerpunkt Infektiologie, Universitätsklinikum Würzburg, ZIM Haus A3/A4, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Miriam von Bibra
- Medizinische Klinik und Poliklinik II, Schwerpunkt Infektiologie, Universitätsklinikum Würzburg, ZIM Haus A3/A4, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Department of Medicine, Tygerberg Hospital, University of Stellenbosch, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Hartwig Klinker
- Medizinische Klinik und Poliklinik II, Schwerpunkt Infektiologie, Universitätsklinikum Würzburg, ZIM Haus A3/A4, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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14
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Calza L, Danese I, Colangeli V, Manfredi R, Magistrelli E, Verucchi G, Conti M, Motta R, Viale P. Plasma concentrations of efavirenz, darunavir/ritonavir and raltegravir in HIV-HCV-coinfected patients without liver cirrhosis in comparison with HIV-monoinfected patients. Infect Dis (Lond) 2015; 47:625-36. [PMID: 25875396 DOI: 10.3109/23744235.2015.1034169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objective of the study was to assess plasma concentrations of efavirenz, darunavir/ritonavir and raltegravir in patients with human immunodeficiency virus-hepatitis C virus (HIV-HCV)-coinfection without liver cirrhosis. METHODS In this observational, open-label study, adult HIV-infected outpatients treated with tenofovir/emtricitabine plus efavirenz (600 mg daily), darunavir/ritonavir (800/100 mg daily) or raltegravir (400 mg twice daily) for at least 4 weeks were asked to participate. Subjects with liver cirrhosis were excluded. The trough concentration (C trough) of darunavir/ritonavir and raltegravir and the mid-dose concentration (C12h) of efavirenz were assessed at steady state by a validated high-performance liquid chromatography (HPLC)-tandem mass spectrometry method. RESULTS A total of 96 HIV-positive patients were enrolled into the study. Thirty-four patients were treated with efavirenz, 33 with darunavir/ritonavir and 29 with raltegravir. The geometric mean plasma C trough [coefficient of variation (%)] of darunavir was comparable between HIV+/HCV+ and HIV+/HCV- subjects: 2644 ng/ml (155%) and 2491 ng/ml (139%), respectively (geometric mean ratio (GMR) = 0.81; 95% confidence interval (CI) = 0.79-1.56; p = 0.69). These values were comparable for raltegravir: 108 ng/ml (149%) in the HIV+/HCV+ group and 96 ng/ml (161%) in the HIV+/HCV- group (GMR = 0.84; 95% CI = 0.61-1.44; p = 0.72). On the contrary, the geometric mean plasma C12h of efavirenz was significantly higher among the 15 HIV+/HCV+ patients (1915 ng/ml, 159%) than among the 19 HIV+/HCV- patients (1505 ng/ml, 167%; GMR = 1.41; 95% CI = 1.19-1.71; p = 0.009). CONCLUSIONS The mean plasma concentration of efavirenz was significantly higher in HCV-positive than in HCV-negative patients without liver cirrhosis, while the mean plasma levels of darunavir/ritonavir and raltegravir were comparable in both groups.
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Affiliation(s)
- Leonardo Calza
- From the 1 Department of Medical and Surgical Sciences, Clinics of Infectious Diseases
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