The COVID-19 pandemic has stalled international efforts to eliminate hepatitis B (HBV) and hepatitis C (HBC), significantly reduced rates of testing among outpatients for these viruses, substantially diminished patient consultations, and greatly increased admissions for alcohol-related hepatitis and other liver diseases among younger patients as alcohol consumption rose during the periods of social isolation, said speakers at a session of the American Association for the Study of Liver Diseases (AASLD) annual meeting.

Reid Grinspoon, a medical student from Harvard Medical School, discussed the results of a study he and colleagues conducted on how the pandemic has affected admissions for alcoholic-associated hepatitis (AH) among younger patients at Massachusetts General Hospital.

Using the Mass General Brigham (MGB) Research Patient Data Registry, the researchers performed chart review on to identify patients ≤ 40 years old admitted with a diagnosis of AH between March 10, 2016, and March 9, 2021, recording demographic information and length of hospital stay. The team also recorded these patients’ Model of End-Stage Liver Disease (MELD) and MELD-Na scores, and Maddrey Discriminant Function (MDF) scores. The data collected included whether the patient was treated in the intensive care unit, underwent liver transplantation, or died. The period March 10, 2020, through March 9, 2021, was designated as the first year of the pandemic (PY1), with the 4 preceding years as the control period.

Of the 157 admissions that met inclusion criteria, 49 occurred in PY1 compared to an average of 27 admissions per year during the control period (p=.004). More than 10% of admissions for AH culminated in liver transplants, “under stringent AH criteria in PY1 vs an average of 1.4%/year in the control period (p=.009). There were no significant differences in the percentages of AH patients who were white (74.5% vs 84.1%, p=.06), Hispanic (18.2% vs 17.8%, p=.9), female (51.0% vs 42.1%, p=.2), treated in the ICU (36.7% vs 27.6%, p=.1), or died (10.2% vs 12.6%, p=.5) between PY1 and the control years,” the authors stated.

“The first year of the COVID-19 pandemic was associated with an 81% increase in AH admissions for patients 40 years or younger at MGB hospitals and resulted in a significant increase in LT in this group,” they concluded. “These data underscore the downstream physical toll of the pandemic among young persons in the form of unhealthy alcohol consumption.”

Worldwide, the SARS-CoV-2 pandemic “impacted substantially on the care of patients with chronic viral hepatitis,” said Maria Buti of Hospital Universitari Vall D'hebron in Barcelona, Spain. Her abstract reported on a study conducted to assess the impact of the COVID-19 pandemic on international goals of viral hepatitis elimination.

The researchers sent a prospective web-based survey to active members of the European Association for the Study of Liver Diseases (EASL) and to major clinical centers in Europe between May and October 2021. The survey measured the total number of outpatient consultations and new referrals for HCV and HBV, hepatitis B surface antigen (HBsAg), HBV DNA, and HCV RNA tests performed during 2019 and 2020, and the number of patients who began treatment for HCV and for HBV. A second part of the survey collected data on the number of participating centers that were also treating patients with COVID-19 during this period.

Responses from 10 major centers in Europe and 21 worldwide revealed that total number of outpatient hepatitis B consultations decreased by 25%, from 28,839 in 2019 to 21,644 in 2020. Hepatitis C outpatient consultations dropped by 44.4% from 23,538 to 13,069). “The main drop was observed, proportionally, in the new referral consultations,” the authors of the abstract wrote.

The total number of tests performed in 2020 declined in most countries. Some 34% of the centers surveyed saw a 50% reduction in hepatitis B surface antigen (HBsAg) testing and a 50% decline in HBV DNA testing in 27% of centers; HCV RNA testing declined by 50% in 44% of centers.

“Lastly, a major reduction of the number of new treatments delivered was uniformly observed,” the authors wrote. “Except for one center, all groups reported less patients starting HCV treatment in 2020, with a drop of >50% in 37% of centers. In 2020, there was a drop of >50% of new HBV treatments in 44% of centers. All centers, except for three, treated also COVID-19 patients.”

--Rebecca Mashaw

Grinspoon, R. Impact of the COVID-19 pandemic on alcohol hepatitis admissions in younger patients in a large urban hospital system. Presented at: The Liver Meeting. November 12-15, 2021. Virtual

Buti, M. COVID-19 impact on viral hepatitis B and C elimination. Preliminary results 31 centres worldwide. Presented at: The Liver Meeting. November 12-15, 2021. Virtual