Can COVID Also Cause Hepatitis?
World Hepatitis Day 2021: FIT explores the link between COVID-19 and hepatitis.
COVID is more than just a flu, of this we know after grappling with it for over a year and a half.
Does COVID also affect the liver?
FIT breaks down the link between COVID-19 and hepatitis.
Can COVID-19 cause hepatitis? We ask Dr (Brig) Pankaj Puri, Director Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi and Dr Geeta Billa, Consultant-Hepatologist, Fortis Hospital, Mumbai.
What is Hepatitis?
First, here is a quick rundown of what hepatitis is.
Hepatitis is an inflammation of the liver. It is most commonly caused by viral infections.
It can be temporary, lasting a few days, or it could last decades. The magnitude of the disease can also vary significantly.
According to WebMD, viral hepatitis including hepatitis A, B, and C, all present different symptoms and require different treatments.
What is autoimmune hepatitis?
Apart from the more common hepatitis caused by viral infection, it can also be caused by a hyperactive immune system.
"Autoimmune Hepatitis is a condition wherein the body’s immunity attacks the Liver, causing significant inflammation in the Liver, and eventually liver failure," explains Dr Billa.
She also adds that the definite cause of autoimmune hepatitis is yet unknown.
Can COVID Cause Hepatitis?
Recent studies have pointed to patients of COVID-19 developing autoimmune hepatitis.
But, before we ring the alarm bells, let's take a closer look at the connection between COVID-19 and hepatitis, and if the link is causal or casual.
Liver damage as a result of COVID infection has been noted in several cases.
"Liver injury caused (by COVID) is usually mild and not a significant cause of concern and is mostly asymptomatic," says Dr Pankaj Puri.
It can, however, lead to potentially serious liver injury in patients with underlying liver disease and sometimes cause mild to severe hepatitis in patients with underlying normal liver.
Dr Billa explains this further, saying, "COVID binds to Angiotensin-Converting Enzyme Receptors (ACE2). One of the highest concentrations of these receptors is in the Liver, so a person with COVID may have liver profile abnormality."
Apart from COVID itself, most medication used in the long run pose a risk of liver damage. This included widely used COVID-19 treatments like remdesivir and hydroxychloroquine as well.
"When steroids and Tocilizumab (immunosuppressants) are used for treatment of COVID, patients with inactive infection or carrier may have increase in viral load and Liver damage."Dr Geeta Billa, Consultant-Hepatologist, Fortis Hospital, Mumbai
Although COVID and COVID treatments can often cause liver damage, Dr Puri explains that this is usually temporary and rarely does it lead to hepatitis.
"In some cases, COVID can, both directly or indirectly, cause hepatitis which could be acute (usually mild) or cause acute exacerbation of underlying chronic liver disease," he says.
These treatments, Dr Puri explains, include both 'allopathic' and herbal drugs.
"We at our center, Fortis Escorts Hospital at New Delhi we have recently encountered cases of AIH precipitated by Giloy, a herb Tinospora Cordifolia, which is often used by persons to prevent Covid 19."Dr (Brig) Pankaj Puri, Director Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute
So the bottom line is, while COVID is known to affect one's liver and cause (likely) temporary damage, there have also been cases of people with normal livers prior to the infection developing AIH.
For this reason, experts recommend monitoring the liver functions of COVID patients constantly, especially those with moderate to severe illness who are on steroids.
Can COVID Vaccines Cause Autoimmune Hepatitis?
Adding to the list of possible COVID vaccine side effects, a recent study published in the science journal Elsevier, links the Covishield COVID vaccine, specifically, to causing autoimmune hepatitis in rare cases.
The study is based on 2 case studies who developed autoimmune hepatitis following COVID vaccination with Covishield.
The study also said that the likelihood of developing AIH was high in predisposed individuals where an immune mediated reaction against hepatocytes is triggered by environmental factors.
"Vaccines are a very rare cause of AIH," it adds.
This study, conducted by The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre and Bharath Institute of Higher Education and Research, Chennai, is the first instance of AIH being reported after any COVID vaccine.
"There is always a possibility that every person's immunity reacts differently to any antigen," says Dr Billa
"The COVID vaccines are antigen stimulus that produces antibodies against the COVID virus. At times, the immunity is altered and rarely the body will produce antibodies against your own Liver."Dr Geeta Billa, Consultant-Hepatologist, Fortis Hospital, Mumbai
"These are two anecdotal reports, in personal practice, I have not encountered any Auto-Immune Hepatitis cases following COVID vaccination," she adds.
The study authors, also, go on to caution against vaccine hesitancy, reiterating the rareness of this side effect.
Moreover, further research will be required to establish a definite causal link between COVID vaccines and AIH.
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