Impact of COVID-19 on the Strategy for the Prevention and Elimination of Hepatitis B and Hepatitis C

Research Article

Austin Pharmacol Pharm. 2023; 7(1): 1028.

Impact of COVID-19 on the Strategy for the Prevention and Elimination of Hepatitis B and Hepatitis C

Antonija Verhaz1,2*

1Clinic for Infectious Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina

2Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina

*Corresponding author: Antonija Verhaz Clinic for Infectious Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina. Tel: 065 649 350 Email: [email protected]

Received: October 07, 2023 Accepted: November 09, 2023 Published: November 16, 2023


The COVID-19 pandemic, since SARS-CoV2 was discovered in December 2019, has resulted in significant morbidity and mortality. Since then, several countries have witnessed the collapse of the health care system due to the great need to treat patients with COVID-19. At the global level, drastic measures have been taken to combat the spread of the virus. However, these measures have led to disruptions in other aspects of health care, diagnosis and treatment of other diseases and conditions. There is also a stalemate in achieving the ambitious goal set by the World Health Organization to eliminate viral hepatitis as a threat to public health by 2030. Hepatitis B and C are chronic conditions with a significant global burden, and COVID-19 has slowed or stopped many hepatitis elimination programs.

Keywords: COVID-19; Chronic hepatitis; World Health Organization


In December 2019, the first case of severe acute respiratory syndrome attributed to SARS-CoV-2 was registered in Wuhan, China, and the disease was named COVID-19 [1]. The ensuing COVID-19 pandemic led to 6,189,593 million deaths by April 16, 2022 [2]. Hepatitis is a global public health challenge because every 30 seconds one person in the world loses their life as a result of hepatitis-related diseases. More than 1.1 million lives are lost each year as a result of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Special emphasis is placed on viral hepatitis B and C, since they belong to the so-called "silent diseases" that pass for a long time without recognized symptoms. Long-term, untreated infection can cause severe liver damage [3,4]. Hepatocellular carcinoma as a result of untreated disease is constantly increasing, and most of them are detected at a stage too late for successful treatment. Testing for hepatitis B and C is the only way to timely detect the disease. The World Health Organization (WHO) estimated in 2016 that the number of people suffering from chronic hepatitis B in the world is 257 million [3], while 71 million people live with chronic hepatitis C [5]. It is estimated that in the world, especially in medium developed and underdeveloped countries, a significant part of the carriers of these viruses remains undiagnosed, due to the low level of testing and availability to health systems [4].

Although it is disputed whether chronic viral hepatitis affects the outcome of COVID-19 [6], worse outcomes with COVID-19 can be expected due to impaired immunity [7]. COVID-19 can also affect the liver and cause its damage, through the direct action of the virus, immune reaction and cytokine storm, and therapy with hepatotoxic drugs [8]. This is especially important for patients with chronic liver diseases in which the remaining liver function is reduced and there may be worsening of the underlying disease and decompensation, as well as the need for transplantation. Furthermore, the pandemic affected the availability of medical services, which is extremely important for the regular monitoring of patients with chronic liver diseases [9]. Due to the cytokine storm, which often occurs in COVID-19 and affects the severity of the clinical picture, both immune-suppressants and corticosteroids are used in the therapy of COVID-19. As a possible side effect of immunosuppressive therapy, reactivation of hepatitis B and C may occur [10]. This may be an important cause of increased morbidity and mortality in patients with previous HBV infection, as a more rapid increase in alanine aminotransferase levels after viral reactivation may lead to liver failure in some cases.

The World Health Organization, promoting the goals of the Global Health Strategy for Viral Hepatitis 2016-2021, which is the elimination of disease and death from hepatitis B and C by 2030, emphasizes the importance of prevention, testing, early detection and treatment of viral hepatitis as a threat to public health by 2030, but also the control of infection caused by the Human Immunodeficiency Virus (HIV) [3,4]. The Sustainable Development Goals include goals such as good coverage of HBV neonatal vaccination, prevention of mother-to-child transmission, and harm reduction programs for intravenous drug users, such as the distribution of sterile syringes and needle kits. The goals of eliminating HCV infection relate to increasing the level of testing of the risk population as well as the general population, implementing harm reduction programs and increasing the availability of new DAA (direct-acting antivirals) drugs. The current pandemic is seriously jeopardizing efforts to achieve these sustainable goals.

The CDC has issued guidance on postponing routine clinic visits as part of initial mitigation strategies for the COVID-19 pandemic [11]. Routine monitoring of laboratory findings, including liver function tests and blood counts, has been significantly reduced due to the increased priority given to tests for COVID-19 [12]. This is likely to result in higher rates of more serious adverse outcomes such as decompensated liver disease and hepatocellular carcinoma. Routine liver tests are also recommended for all patients with COVID-19 disease, especially those receiving remdesivir and tocilizumab, regardless of their baseline values [10]. Delays in health services during a pandemic can lead to delays in diagnosis and treatment, leaving people living with hepatitis B and C unaware of their disease status and vulnerable to the progression of liver disease, including cirrhosis and hepatocellular carcinoma, as well as the potential spread of the virus [13]. Due to interrupted and poor-quality treatment of viral hepatitis, there is an increased risk of an increase in the incidence of hepatitis B and C, which could increase transmission in the population and affect the development of resistance to antiviral drugs. An important role in the elimination of hepatitis is played by infectious disease specialists and family medicine doctors, who are now in the focus of the COVID-19 pandemic, and this change can further affect hepatitis elimination programs. Countries with few doctors will be more affected [14].


To assess the impact of the COVID-19 pandemic on the provision of viral hepatitis testing services at the Infectious Diseases Clinic of the University Clinical Center of the Republika Srpska Banja Luka, the number of registered chronic hepatitis B and C in the years of the pandemic compared to the previous period, and the availability of treatment with DAA drugs against hepatitis C during the pandemic.

Material and Methods

The results were obtained through a retrospective analysis of data from the diagnostic and treatment protocols of the Infectious Diseases Clinic of the University Clinical Center of the Republika Srpska Banja Luka as a reference institution for the treatment of viral hepatitis and HIV infection. The process of Voluntary and Confidential Counseling and Testing (VCCT) consists of pre-testing, testing and post-testing counseling for HIV/HBV/ HCV viruses. The consultation center of the Clinic for Infectious Diseases is a reference center for voluntary, free and anonymous testing.


The Clinic for Infectious Diseases of the University Clinical Center of the Republika Srpska in Banja Luka is a reference institution for the treatment of chronic viral hepatitis and HIV infection. About one million inhabitants gravitate to this region. The beginning of the pandemic in 2020 was also marked by a significant drop in the level of client testing in the clinic's Counseling Center compared to the years before the pandemic (Table 1).