Covid-19’s impact on liver
Since December 2019, the world is learning to adapt to a new normal and at the same time, new words are being introduced into our vocabulary regularly.
Since it is now well established that Covid-19 affects the liver in addition to lungs, heart, kidneys, eyes and so on, we -- hepatologists -- are learning too.
We are trying to remain updated on "COVALI" or Covid-19-associated liver injury that is yet to be included in hepatology textbooks but is currently dominating scientific literature.
The task is no easy one, as to date, there are more than 3,000 indexed publications on COVALI.
If infected with SARS-CoV-2, people without any liver disease can develop mild hepatitis with some derangement of liver function -- characterised by elevation of serum bilirubin and liver enzymes.
However, such hepatitis is usually self-limiting. The same also applies to those who have chronic hepatitis or persistent liver inflammation due to a variety of causes, namely hepatitis B and C viruses and fatty liver. In them, Covid-19 usually also runs a benign course.
Those who are suffering from liver cirrhosis are usually not that lucky. A large Asia Pacific study late last year reported that in such patients, Covid-19 is associated with up to 43 percent mortality against the approximately 1.5 percent that we have been experiencing in Bangladesh due to the virus.
These data include liver cirrhotic patients from Bangladesh too, as we from the Hepatology Department of Bangabandhu Sheikh Mujib Medical University participated in this groundbreaking study that established, for the first time, another fatal aspect of Covid-19.
Liver cirrhosis patients who survive Covid-19 may experience marked deterioration of their liver function. The affected liver may take a long time to recover. In some cases, it may not recover at all.
One more important aspect of COVALI is that the drugs commonly used for Covid-19 treatment are hepatotoxic or injurious to the liver in many cases. The list is long and steroids may induce a flare-up of hepatitis B.
This does not, however, mean that patients with pre-existing liver disease cannot be treated for Covid-19, rather it implies that extra caution should be taken in treating such patients with a combination of drugs.
The other important issue concerning Covid-19 and the liver is whether liver disease patients can be vaccinated. The answer is a short and simple "yes".
All Covid-19 vaccines approved in Bangladesh are safe for liver disease patients. There is no published literature reporting any adverse event in any liver disease patient anywhere in the world.
We have also issued guidance from Forum for the Study of the Liver in Bangladesh and BSMMU Hepatology Alumni Association in this regard a few months back, which was widely circulated.
Covid-19 is new and therefore the knowledge about what it does to the liver is also evolving.
The writer is the chief of Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University and a member of Strategic and Technical Advisory Group, WHO-SEAR.
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