A significant proportion of patients infected with SARS-CoV-2 develop severe respiratory symptoms due to an excessive immune response Treatment of this condition may include immunosuppressive therapies, such as IL-6 receptor antagonists and corticosteroids, which poses a risk for patients with active or past hepatitis B virus (HBV) infection In this prospective cohort study we analyzed the risk of HBV reactivation in patients with severe COVID-19 and resolved HBV infection undergoing immunosuppressive therapy From March 15(th) to April 30(th) 2020, 600 patients with severe COVID-19 were admitted into our Hospital and treated with immune-modulators Data regarding HBV infection was available in 484, of whom 69 (14%) were HBsAg negative/anti-HBc positive For these patients, HBV reactivation prophylaxis with entecavir was strongly recommended Complete follow-up was available in 61 patients: 72% were male, median age was 67 years, and anti-HBs was &gt;10 IU/mL in 72% The immunosuppressive drug most used was tocilizumab (72%) Despite HBV prophylaxis recommendation, 38 (62%) patients received entecavir and 23 (38%) did not Baseline features of both groups were similar At follow-up, we found no cases of HBsAg seroreversion and only 2 (3%) patients (no prophylaxis group) had detectable serum HBV-DNA (&lt;15 IU/mL) Both were anti-HBs negative and had normal aminotransferase levels Our data show that the risk of HBV reactivation in patients with severe COVID-19 and resolved HBV infection undergoing immunosuppressive treatment is low However, if a systematic follow-up after hospital discharge is unfeasible in patients without anti-HBs, a short course of antiviral prophylaxis may be a safe option
Low risk of hepatitis b reactivation in patients with severe COVID-19 who receive immunosuppressive therapy