Current and past infections of hepatitis B virus do not increase mortality in patients with COVID-19.

BACKGROUND & AIMS: We compared risk of acute liver injury and mortality in COVID-19 patients with current, past, and no hepatitis B virus (HBV) infection. APPROACH & RESULTS: This was a territory-wide retrospective cohort study in Hong Kong. COVID-19 patients between 23 January 2020 and 1 January 2021 were identified. Patients with hepatitis C or no hepatitis B surface antigen results were excluded. The primary outcome was mortality. Acute liver injury was defined as alanine aminotransferase or aspartate aminotransferase ≥2x upper limit of normal (ULN) (i.e. 80U/L), with total bilirubin ≥2xULN (i.e. 2.2mg/dL) and/or international normalized ratio ≥1.7. Of 5,639 patients included, 353 (6.3%) and 359 (6.4%) had current and past HBV infection, respectively. Compared to patients without known HBV exposure, current HBV-infected patients were older, and more likely to have cirrhosis. Past HBV-infected patients were the oldest, and more had diabetes and cardiovascular disease. At a median follow-up of 14 (9-20) days, 138 (2.4%) patients died; acute liver injury occurred in 58 (1.2%), 8 (2.3%), and 11 (3.1%) patients with no, current, and past HBV infection, respectively. Acute liver injury (adjusted hazard ratio [aHR] 2.45, 95% CI 1.52-3.96, P<0.001), but not current (aHR 1.29, 95% CI 0.61-2.70, P=0.507) or past HBV infection (aHR 0.90, 95% CI 0.56-1.46, P=0.681), was associated with mortality. Corticosteroid, antifungal, ribavirin, and lopinavir-ritonavir use (adjusted odds ratio [aOR] ranged from 2.55-5.63), but not current (aOR 1.93, 95% CI 0.88-4.24, P=0.102) or past HBV infection (aOR 1.25, 95% CI 0.62-2.55, P=0.533), were associated with acute liver injury. CONCLUSION: Current or past HBV infections were not associated with more liver injury and mortality in COVID-19.