ASHM COVID-19 Regional Advisory Group interim guidance of HBV summary

ASHM regional task force Covid 19

HBV recommendations regarding COVID-19. 
Summary

ASHM Regional Advisory Group interim HBV recommendations

 

Prepared by Professor Benjamin Cowie and the ASHM COVID-19 Regional Advisory Group, clinical care and priority populations sub-groups.

 

UPDATED ON: May 26th 2020

 

 

 

The guidance is adapted from the ASHM COVID-19 Taskforce interim recommendations regarding COVID-19 and adults living with chronic hepatitis B.

Disclaimer: The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence but will be revised to include relevant future systematic review findings. The recommendations are not intended to replace national guidance.  

 

1. Streamline routine care for people living with hepatitis B
if stable/adherent on treatment, treatment not indicated, no cirrhosis, no comorbidities

  • deferred clinic visits and phone/tele visits
  • deferred blood tests
  • consider referral to service local to patient shift
  • dispensing at pharmacy local to patient
  • prescriptions sent to patient or pharmacy

 

2. Prioritise new patients, initiation of antiviral treatment, and care for patients with cirrhosis

3. Preventive care:

  • influenza vaccination
  • pneumococcal vaccination
  • assess and advise on alcohol use; support ceasing alcohol if cirrhosis
  • stop smoking

4. Protect antiviral supply

  • ensure pharmacies review and maintain adequate buffer stock
  • ensure access to local pharmacy with prescription
  • liaise with pharmacies patients are attending
  • protect stocks by discouraging large personal supplies
  • small personal 1-2 mo buffer stock if local supplies permit
  • refill prescriptions early

5. Check adherence

6. Check Psychosocial status: connect patients to available services

  • Mental health
  • Drug and alcohol
  • Housing and security
  • Poverty
  • Food supply and security

7. Connect with CBOs

  • CBOs and outreach workers can support clinicians to support patients

8. Optimise health for older patients and comorbidities.

  • E.g. cirrhosis, older age, diabetes, hypertension, cardiovascular disease, lung disease, cancer, diabetes [1-5]
  • do not stop or change ACE inhibitors or angiotensin receptor blocker medications for high blood pressure[6]

 

HBV and COVID-19

  • There is no evidence that living with chronic HBV is itself a risk for severe COVID-19
  • Patients with HBV are expected to recover as well as other patients
  • Patients with HBV should get the same high level of care for COVID-19, including hospital admission, oxygen, intensive care, ventilator support [link to our document]

Patients likely to more of severe illness include those with:

  • cirrhosis
  • hepatocellular carcinoma
  • liver transplant

Managing people living with chronic hepatitis B with COVID-19 symptoms:

  • advocate for the same level of care for people living with chronic hepatitis B in hospital
  • caution in interpreting LFTs taken during acute illness which may be elevated.
  • do not interrupt hepatitis B treatment

Adhere to measures that reduce COVID infection
Social/physical distancing

  • Patient wear a mask
  • Regular hand washing
  • Refraining from touching the face
  • Cough etiquette
  • Social isolation of contacts & those with mild symptoms
  1. Wang, D., et al., Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 2020.
  2. Wu, Z. and J.M. McGoogan, Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA, 2020.
  3. Zhou, F., et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020. 395(10229): p. 1054-1062.
  4. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. .
  5. Porcheddu, R., et al., Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV-2 in Italy and China. J Infect Dev Ctries, 2020. 14(2): p. 125-128.
  6. Vaduganathan, M., et al., Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med, 2020.