eCase - Viral Hepatitis in the COVID-19 Era

This Clinical Focus module will center on lessons learned on the interplay of COVID-19 and viral hepatitis–related liver disease. We will look at COVID-19 risk and outcomes in patients with chronic liver disease (CLD) and expert guidance on the management of such patients. Finally, we will discuss vaccine recommendations for our patients with immune suppression, and the lessons we have learned from managing liver disease and COVID-19 using telemedicine during the pandemic.

The slide thumbnails in this activity link to a complete PowerPoint slideset that can be found here or downloaded by clicking any of the thumbnails within the activity.

Clinical Care Options plans to measure the educational impact of this activity, and some questions will be asked twice: once before the discussion that informs the best choice and again after that specific discussion. Your responses will be aggregated for analysis, but your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions

You are caring for a 52-year-old man hospitalized with COVID-19. His liver enzymes are elevated to approximately 3 times the upper limit of normal. His history includes injecting drugs and he experiences unstable housing. He was diagnosed with chronic hepatitis C 2 years ago at a street medicine clinic but did not follow up because of COVID-19 pandemic lockdowns and so remains treatment naive.

If following American Association for the Study of Liver Diseases (AASLD) guidance, after ruling out drug-induced liver injury, the next step should be:

A. Monitor liver enzymes for 1 week
B. Obtain MRI of the liver
C. Obtain a liver biopsy
D. Test for hepatitis A and B
E. I’m uncertain

This patient’s hepatitis B panel is positive for hepatitis B surface antigen. Which viral hepatitis management approach is best supported by AASLD guidance?

A. Initiate treatment for hepatitis B and C
B. Initiate treatment for hepatitis B; defer hepatitis C treatment until after recovery from COVID-19
C. Initiate treatment for hepatitis C; defer hepatitis B treatment until after recovery from COVID-19
D. Defer treatment for hepatitis B and C until after recovery from COVID-19
E. I’m uncertain

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Lessons Learned From Lockdown: Viral Hepatitis–Related Liver Disease in the COVID-19 Era

Robert G. Gish, MD

Activity

If following American Association for the Study of Liver Diseases (AASLD) guidance, after ruling out drug-induced liver injury, the next step should be:

This patient’s hepatitis B panel is positive for hepatitis B surface antigen. Which viral hepatitis management approach is best supported by AASLD guidance?