The Role of COVID-19 Vaccination in Individuals with Chronic Hepatitis B Infection


Study presented at CROI 2024 reveals chronic hepatitis B virus (HBV) infection heightens COVID-19 severity as vaccination reduces mortality and ICU demands in co-infected individuals.

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Chronic infection with HBV is considered a potential risk factor for severe COVID-19, as evidenced by its influence on COVID-19 outcomes in those simultaneously infected with COVID-19 and HBV infection (COVID-HBV). In the most comprehensive study on this topic so far, having chronic HBV infection was associated with increased chances of death and negative outcomes from COVID-19.

Among 3,360,173 individuals with confirmed COVID-19, approximately 0.2% (7,163) had concurrent COVID-HBV, of whom 13.9% (996) were vaccinated. Individuals with COVID-HBV experienced higher odds of mortality within 90 days (OR 1.21, 95% CI 1.02-1.44; p = 0.032) and higher odds of requiring ICU admission (OR 1.39, 95% CI 1.17-1.66; p < 0.001) compared to those without HBV (COVID-wo-HBV). However, no significant differences were observed in 30-day mortality, rates of hospitalization, and mechanical ventilation between the 2 groups.

Researchers used the TriNetX database to compare adult patients with confirmed COVID-HBV and COVID-wo-HBV who sought care across 77 healthcare systems in the US from January 2020 to August 2023. The analysis encompassed individuals identified with HBV through diagnostic codes and laboratory assessments. The researchers assessed the risk of outcomes including inpatient hospitalization, ICU admission, mechanical ventilation usage, as well as mortality within 30 days (early) and 90 days (late).

Although vaccination against COVID-19 has been linked to a decreased risk of mortality and negative outcomes in the broader population, its effectiveness in improving COVID-19 outcomes among those with ongoing HBV infection has yet to be determined. In a specific analysis of the COVID-HBV subgroup, those vaccinated against COVID-19 showed reduced odds of mortality at both 30 days (OR 0.38, 95% CI 0.22-0.66; p < 0.001) and 90 days (OR 0.46, 95% CI 0.31-0.70; p < 0.001). Nevertheless, vaccination did not significantly affect the odds of hospitalization, ICU admissions, or the need for mechanical ventilation.

To mitigate potential confounding variables, the investigators applied 1:1 propensity score matching, considering demographics, significant comorbidities, and COVID-19 vaccination status. OR and 95% CI were calculated for the specified outcomes, with a p-value of less than 0.05 indicating statistical significance.

This research on the protective effects of COVID-19 vaccination in individuals with chronic HBV infection is highlighted at the ongoing Conference on Retroviruses and Opportunistic Infections (CROI). Plans for further studies are in place, utilizing data spanning a longer timeframe, to confirm the sustainability of these beneficial outcomes as vaccination efforts continue.


Yendewa G, Olasehinde T, Mulindwa, et. al. Chronic Hepatitis B Increases Mortality Risk in COVID-19 While Vaccination Is Protective. Poster #730 presented at CROI 2024. March 3-6, 2023. Denver, CO.

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