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  • Chronic hepatitis C virus (HCV) infection causes ongoing liver injury that leads to serious complications in the long-term
  • Many people with HCV have other health conditions that, in theory, increase their chances of developing severe COVID-19
  • A study found that people with HCV and COVID-19 were at increased risk for hospitalization but not death

Exposure to hepatitis C (HCV) can lead to this virus infecting the liver. Chronic HCV infection causes persistent inflammation within the liver that slowly degrades this vital organ. If HCV is undiagnosed and untreated, the liver becomes chronically inflamed. In turn, chronic inflammation causes healthy liver cells to be replaced with useless scar tissue in a process called fibrosis. As the amount of scar tissue accumulates, the liver becomes less able to function and complications ensue, including severe fatigue, internal bleeding, serious abdominal infections, kidney injury and liver failure. The presence of scar tissue within the liver also increases the risk for liver cancer.

Chronic HCV infection can be cured in many people with only eight consecutive weeks of treatment. Many treatments for HCV are available in Canada and other high-income countries and are usually taken once daily.

Some people with chronic HCV infection can have co-existing health conditions, including the following:

  • higher-than-normal blood pressure
  • cardiovascular disease
  • diabetes
  • obesity

Hepatitis C and COVID-19

A virus called SARS-CoV-2 can cause an illness called coronavirus disease-2019 (COVID-19).

In general, studies in people without HCV have found that the presence of the previously mentioned health conditions (among others) can increase the risk for severe manifestations of COVID-19.

Doctors in Pittsburgh and other cities in the U.S. cooperated in a study where they investigated the risk for hospitalization and death in people with and without HCV infection, all of whom had been diagnosed with COVID-19.

The doctors found that people with HCV infection were significantly more likely to be hospitalized once they developed COVID-19 compared to people without HCV who developed COVID-19. However, people with HCV who also had COVID-19 were not at increased risk for being admitted to an intensive care unit (ICU) or dying once hospitalized.

Study details

Researchers used a large database that collected health-related information on U.S. veterans. The researchers selected participants who did not have HIV or hepatitis B virus (HBV). They matched data from 975 people who had active HCV infection with data from 975 other people who did not have HCV infection. All 1,950 people in the study were diagnosed with SARS-CoV-2 infection and subsequently COVID-19. Each person with HCV was compared to another person without HCV of the same gender and of similar age, race and body mass index (BMI). Each pair of people who were compared had similar levels/diagnoses of the following:

  • alcohol use
  • higher-than-normal blood pressure
  • cancer
  • cardiovascular disease
  • diabetes
  • smoking

Researchers also took into account the degree of liver injury and scaring of this organ from different causes – HCV infection, excessive alcohol consumption and so on.

SARS-CoV-2 infection was diagnosed by PCR (polymerase chain reaction) testing.


People with HCV infection were significantly more likely (8%) to have moderate-to-severe liver injury compared to HCV-negative people (1%).


People who had HCV and COVID-19 were more likely to be hospitalized (24%) than people without HCV who also had COVID-19 (18%). Among hospitalized people, rates of admission to the ICU were similar regardless of HCV status.

Factors such as age, race and gender did not affect the risk of hospitalization. However, among all people with mild-to-moderate liver injury, those who also had HCV infection were twice as likely to be hospitalized compared to people without HCV. Furthermore, among people with extensive scarring of the liver, those who also had HCV were 16-fold more likely to be hospitalized compared to people without HCV.


The proportion of people who died was similar among people with HCV (6.6%) and people without HCV (6.5%).

According to the researchers, “a very small proportion of persons in our study received the antiviral drug remdesivir, systemic corticosteroids or both agents. The number of [deaths] among those receiving those agents was too small to make meaningful comparisons of their effect on mortality.”

Bear in mind

The present study was observational in its design and its conclusions cannot be definitive. However, it investigates the impact of COVID-19 on hospitalization and survival of people with HCV. It had a control group—people without HCV who were demographically similar—so this is a key strength, as clear comparisons could be made. This study is therefore useful and important. Hopefully it will stimulate other research teams to conduct similar analyses to confirm the present study’s findings.

The study underscores the impact of HCV infection and liver injury on the risk of hospitalization in people who develop COVID-19.

Health systems and clinics need to intensify their outreach and connection with vulnerable populations with HCV so that care and treatment can be offered and cure of HCV can be achieved.

—Sean R. Hosein


COVID-19 resources

Hepatitis C: An In-Depth Guide – CATIE

Understanding Cirrhosis of the Liver: First steps for the newly diagnosed – CATIE, Canadian Association of Hepatology Nurses (CAHN)


Butt AA, Yan P, Chotani RA, et al. Mortality is not increased in SARS-CoV-2 infected persons with hepatitis C virus infection. Liver International. 2021; in press.