Yendewa George A, Olasehinde Temitope, Mulindwa Frank, Salata Robert A, Mohareb Amir M, Jacobson Jeffrey M
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Open Forum Infect Dis. 2025 Jan 10;12(2):ofaf013. doi: 10.1093/ofid/ofaf013. eCollection 2025 Feb.
There is conflicting evidence regarding the impact of chronic hepatitis B virus (HBV) on SARS-CoV-2 outcomes. Additionally, the impact of SARS-CoV-2 vaccination and variant periods on outcomes in HBV/SARS-CoV-2 coinfection remain unexplored.
We utilized the TriNetX database to compare adults with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) across 97 US healthcare systems from 2020 to 2023. We assessed the odds of all inpatient hospitalizations, intensive care unit admissions, mechanical ventilation, 30-day, 90-day, and overall mortality. In sensitivity analyses, we excluded HIV, hepatitis C virus, and transplant cases and stratified the HBV/SARS-CoV-2 cohort by cirrhosis status. We applied propensity score matching to address confounding and reported odds ratios (OR) with 95% confidence intervals (CI).
Of 4 206 774 individuals with SARS-CoV-2, about 0.2% (8293) were HBV/SARS-CoV-2. Individuals with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) had higher odds of intensive care unit admissions (OR, 1.18; 95% CI, 1.02-1.36), 90-day (OR, 1.22; 95% CI, 1.01-1.41) and overall mortality (OR, 1.18; 95% CI, 1.06-1.33). In sensitivity analyses, those with HBV/SARS-CoV-2 and cirrhosis had a 2.0- to 2.50-fold higher odds of adverse outcomes. Notably, even individuals with HBV/SARS-CoV-2 without cirrhosis had higher odds of mortality. Vaccinated (vs unvaccinated) individuals with HBV/SARS-CoV-2 had 57%, 54%, and 29% reduction in 30-day, 90-day, and overall mortality, respectively. The pre-Delta variant period was associated with higher odds of hospitalization compared to the Omicron but not the Delta period.
Chronic HBV was associated with worse SARS-CoV-2 outcomes, whereas SARS-CoV-2 vaccination reduced the likelihood of adverse outcomes.
关于慢性乙型肝炎病毒（HBV）对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染结局的影响，证据存在冲突。此外，SARS-CoV-2疫苗接种和病毒变异时期对HBV/SARS-CoV-2合并感染结局的影响仍未得到探索。
我们利用TriNetX数据库，比较了2020年至2023年美国97个医疗系统中患有HBV/SARS-CoV-2的成年人（与仅感染SARS-CoV-2的成年人）。我们评估了所有住院、重症监护病房收治、机械通气、30天、90天和总体死亡率的比值比。在敏感性分析中，我们排除了感染人类免疫缺陷病毒（HIV）、丙型肝炎病毒的病例以及移植病例，并根据肝硬化状态对HBV/SARS-CoV-2队列进行分层。我们应用倾向评分匹配来解决混杂问题，并报告了具有95%置信区间（CI）的比值比（OR）。
在4206774例感染SARS-CoV-2的个体中，约0.2%（8293例）为HBV/SARS-CoV-2合并感染。HBV/SARS-CoV-2合并感染的个体（与仅感染SARS-CoV-2的个体相比）进入重症监护病房的几率更高（OR，1.18；95%CI，1.02 - 1.36），90天死亡率（OR，1.22；95%CI，1.01 - 1.41）和总体死亡率（OR，1.18；95%CI，1.06 - 1.33）也更高。在敏感性分析中，患有HBV/SARS-CoV-2且合并肝硬化的个体出现不良结局的几率高出2.0至2.50倍。值得注意的是，即使是没有肝硬化的HBV/SARS-CoV-2合并感染个体，死亡率也更高。接种疫苗的HBV/SARS-CoV-2合并感染个体（与未接种疫苗的个体相比）30天、90天和总体死亡率分别降低了57%、54%和29%。与奥密克戎变异株时期相比，在德尔塔变异株出现之前的时期住院几率更高，但与德尔塔变异株时期无关。
慢性HBV感染与更差的SARS-CoV-2感染结局相关，而SARS-CoV-2疫苗接种降低了不良结局的可能性。
