What to Know About Liver Disease and COVID-19

Some patients hospitalized for COVID-19 have had increased levels of liver enzymes — like alanine aminotransferase (ALT) and aspartate aminotransferase (AST) — that indicate their livers are at least temporarily damaged. Also, liver damage is more common in patients who have severe COVID-19 disease. However, we do not know if this increase in liver enzyme levels is related directly to the virus that causes COVID-19 (SARS-CoV-2) being in the liver or if liver damage results from other factors.

More research is needed to determine if COVID-19 patients with hepatitis B, hepatitis C, cirrhosis, fatty liver, and other chronic liver diseases are more likely to suffer from liver damage than COVID-19 patients without chronic liver disease.

Currently, we have no information about whether people with hepatitis B or hepatitis C are at increased risk for getting COVID-19 or having severe COVID-19. However, based on available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions, including people with liver disease, might be at higher risk for severe illness from COVID-19, particularly if the underlying medical conditions are not well controlled.

We do not know whether patients with hepatocellular carcinoma (HCC) are at higher risk for severe COVID-19 than those without HCC. However, one study reported a link between cancer and worse COVID-19 disease or death. Cancer patients with weakened immune systems after chemotherapy are more likely to get infections with other germs and it is possible that this is the case with SARS-CoV-2 as well.  However, SARS-CoV-2 spreads easily, even for people with healthy immune systems. People of all ages with serious underlying medical conditions are at higher risk for severe COVID-19, particularly if the underlying medical conditions are not well controlled.

Hepatitis A outbreaks are still ongoing in over 30 states during the COVID-19 pandemic. People in all states who are at high risk for hepatitis A infection should continue to practice good hand hygiene and avoid large gatherings during the COVID-19 pandemic. They should also request hepatitis A vaccine from their healthcare providers during their next visit.

If you are a member of any of these groups, and if you are contacting your provider for any reason, you should request the hepatitis A vaccine:

• People who use drugs (injection or non-injection)
• People experiencing unstable housing or homelessness
• Men who have sex with men (MSM)
• People who are or were recently incarcerated (e.g., in prison)
• People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C

The best way to protect yourself from getting COVID-19 is to avoid exposure to the SARS-CoV-2 virus. People with liver disease should take the same preventive actions being taken by people with other underlying conditions to avoid getting sick with or spreading COVID-19.

People with hepatitis B or hepatitis C should also continue to maintain a healthy lifestyle. If you have hepatitis B or hepatitis C and are being treated for your infection, it is important to continue your treatment and follow the advice of your healthcare provider. This is the best way to keep your immune system healthy.

The best way to avoid COVID-19 is to avoid exposure to the SARS-CoV-2 virus. People with liver disease should take the same preventive actions being taken by people with other underlying conditions to avoid getting sick with or spreading COVID-19. In addition, people with substance use disorder should stay in contact with their primary care provider and continue prescribed treatments. People who inject drugs should continue to use sterile injection equipment.

Call your healthcare provider if you develop symptoms of COVID-19 or if you have been exposed to someone known to have COVID-19. Discuss how to get evaluated and how to avoid spreading the virus to others.

Learn more about COVID-19 and what to do if you get sick.

People with chronic liver disease should take steps that everyone can take to prevent getting COVID-19. They should also take the same preventive actions being taken by people with other serious underlying medical conditions to avoid getting sick with or spreading COVID-19.

In addition, people with chronic liver disease can take the following measures:

• If you are currently taking treatment for hepatitis B or hepatitis C, or other chronic conditions, make sure you have enough of your medication at home to reduce unnecessary visits to health services or pharmacies. You may be eligible for up to a 90-day supply of medication.
• Talk to your healthcare provider about vaccination. CDC recommends that people with chronic liver disease receive vaccinations against hepatitis A, hepatitis B, influenza (flu), and pneumococcal disease.
• If you must stay at home for a couple of weeks, come up with a plan to continue your care. Try to establish a telemedicine link through your hepatitis provider’s online portal. If telemedicine is not available to you, make sure you can communicate with your provider by phone or text.
• Make sure you can maintain a social network remotely, such as online, by phone, or by video chat. This can help you stay socially connected and mentally healthy.
• Smoking or vaping tobacco or marijuanaexternal icon could increase your risk of severe respiratory illness. Quitting smoking or vaping may reduce your chances of developing serious complications from COVID-19.
• If you become sick, make sure you stay in touch by phone or email with people who can help you.

We do not know at this time. Currently there are no drugs approved by the U.S. Food and Drug Administration (FDA)external icon specifically for the treatment of COVID-19, although FDA has granted an Emergency Use Authorization for the use of remdesivir to treat severe cases. Remdesivir is not used to treat hepatitis B or hepatitis C.

Researchers are studying new drugs and drugs that are already approved for other health conditions to determine their safety and effectiveness in treating COVID-19. In the meantime, never take a prescription medicine or drug if it is not prescribed for you by your doctor for your health condition.

No drug shortages or anticipated problems with medicine used to treat hepatitis B or hepatitis C have been identified to date.

The U.S. Food and Drug Administration (FDA) is closely monitoring the drug supply chain because the COVID-19 outbreak has the potential to disrupt the supply of medical and pharmaceutical products in the United States.

Learn more about the FDA’s response to COVID-19external icon and information on drug shortagesexternal icon.

People with chronic liver disease, like others with higher risk for severe COVID-19 illnesspdf icon, should stay at home if possible, and avoid unnecessary travel.

For the latest CDC travel recommendations, visit CDC’s COVID-19 travel information page.

Minimizing stigma and misinformation about COVID-19 is very important. People with liver disease have experience in dealing with stigma and can be allies in preventing COVID-19 stigma. Learn how you can reduce stigma and help prevent the spread of rumors about COVID-19.