Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
PLoS One. 2021 Oct 5;16(10):e0258229. doi: 10.1371/journal.pone.0258229. eCollection 2021.
BACKGROUND/AIMS: We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.
In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19.
The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57-0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37-0.66), while treatment was not associated with severe clinical outcomes of COVID-19.
Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.
背景/目的：我们检测了慢性乙型肝炎（CHB）基础疾病和抗病毒治疗与 SARS-CoV-2 检测患者感染率之间的相关性。
共纳入 204418 名 2020 年 1 月至 6 月间接受 SARS-CoV-2 检测的患者。对每位 SARS-CoV-2 检测阳性的病例患者（n=7723），我们从目标人群中随机选择了 46231 名接触过 COVID-19 但 SARS-CoV-2 检测结果为阴性的对照者。我们合并了从韩国国家健康保险服务数据库中收集的基于索赔的资料。主要终点为 SARS-CoV-2 感染和 COVID-19 的严重临床结局。
在 COVID-19 阳性患者（n=267，3.5%）中，基础 CHB 的比例低于 COVID-19 阴性对照者（n=2482，5.4%）。在调整了合并症后，基础 CHB 与 SARS-CoV-2 阳性率降低相关（调整后的优势比[aOR]0.65；95%置信区间[CI]，0.57-0.74）。在确诊 COVID-19 的患者中，基础 CHB 使 COVID-19 严重临床结局的风险增加了 66%，但该值无统计学意义。包括替诺福韦和恩替卡韦在内的抗病毒治疗与 SARS-CoV-2 阳性率降低相关（aOR 0.49；95%CI，0.37-0.66），但治疗与 COVID-19 的严重临床结局无关。
基础 CHB 和包括替诺福韦在内的抗病毒药物降低了对 SARS-CoV-2 感染的易感性。HBV 合并感染不会增加疾病严重程度的风险，也不会导致 COVID-19 的预后更差。
