Dear Editor:
We appreciate the comment by Lv et al on our article. In our study, we aimed to describe the characteristics of liver function and its relationship with severity of disease and prognosis of patients with severe acute respiratory syndrome–associated coronavirus 2 (SARS-CoV-2) and chronic hepatitis B virus (HBV) coinfection. Therefore, only patients with SARS-CoV-2 and chronic HBV coinfection were enrolled. Although we did not compare coronavirus disease 2019 (COVID-19) patients with HBV coinfection and patients with SARS-CoV-2 infection alone in our study, Chen et al1 found no significant differences in liver function parameters, discharge rate, length of stay, severity, and mortality between COVID-19 patients with and without HBV infection. We fully agree with the comment by Lv et al that “the clinical stage of included patients cannot be determined”. Because of lack of baseline levels of alanine aminotransferase and HBV DNA, patients could not be grouped according to the chronic HBV infection phases. We acknowledged this in the limitations of our article. Thirteen patients had taken anti-HBV nucleotide/nucleoside analogue therapy on admission and during hospitalization. Because patients could have received several drugs for COVID-19 and 13.33% patients experienced liver injury after treatments, the association between drugs and liver injury could not be analyzed, as described in the limitations.
Despite the limitations, we found that patients with liver injury were more likely to experience poor prognosis including higher proportions of complications and death than patients without liver injury. Our results show that abnormalities in liver function should be taken seriously especially within the first week of admission. The mechanism underlying liver injury is yet unclear and needs to be further investigated. It has been reported that HBV reactivation could be caused by COVID-19.2 HBV DNA should be monitored in patients with chronic hepatitis B.
Footnotes
Conflicts of interest The authors disclose no conflicts.
Funding Supported by the Fundamental Research Funds for the Central Universities, China (2020kfyXGYJ087).
References
- 1.Chen L., Huang S., Yang J. Clinical characteristics in patients with SARS-CoV-2/HBV co-infection. J Viral Hepat. 2020 doi: 10.1111/jvh.13362. [epub ahead of print] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Aldhaleei W.A., Alnuaimi A., Bhagavathula A.S. COVID-19 induced hepatitis B virus reactivation: a novel case from the United Arab Emirates. Cureus. 2020;12 doi: 10.7759/cureus.8645. [DOI] [PMC free article] [PubMed] [Google Scholar]