What to Know About Liver Disease and COVID-19

Some patients hospitalized for COVID-19 have had increased levels of liver enzymes — such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Increased levels of liver enzymes can mean that a person’s liver is at least temporarily damaged. People with cirrhosis [liver scarring] may be at increased risk of COVID-19. Some studies have shown that people with pre-existing liver disease (chronic liver disease, cirrhosis, or related complications) who were diagnosed with COVID-19 are at higher risk of death than people without pre-existing liver disease.

Adults of any age with certain underlying medical conditions, including people with liver disease (such as hepatitis B or hepatitis C), might be at increased risk for severe illness from the virus that causes COVID-19. People might be more likely to have severe disease if their medical conditions are not well controlled. People who are on treatment for hepatitis B or C should continue their treatment unless otherwise directed by their healthcare provider.

Patients with hepatocellular carcinoma (HCC), which occurs most often in people with chronic liver diseases such as hepatitis B or hepatitis C, are at higher risk for severe COVID-19 than those without HCC. Cancer patients with weakened immune systems after chemotherapy are more likely to get infections with other germs, and it is possible that this is the case with COVID-19 as well. COVID-19 spreads easily, even among people with healthy immune systems. Adults of any age with certain underlying medical conditions are at higher risk for severe COVID-19.

Hepatitis A outbreaks are still ongoing during the COVID-19 pandemic. People in all states who are at high risk for hepatitis A infection should take steps to protect themselves from COVID-19 and slow the spread including: wear a mask, stay 6 feet from people who don’t live with you, avoid crowds and poorly ventilated spaces, and wash your hands often. If soap and water aren’t available, use hand sanitizer containing at least 60% alcohol. They should also request hepatitis A vaccine from their healthcare providers during their next visit, if they have not already received it.

If you are a member of any of these groups, contact your healthcare provider to request the hepatitis A vaccine:

• People who use drugs (injection or non-injection)
• People experiencing unstable housing or homelessness
• Men who have sex with men (MSM)
• People who are or were recently incarcerated (e.g., in prison)
• People with chronic liver disease, including cirrhosis, hepatitis B or C

The best way to avoid COVID-19 is to avoid exposure to the virus that causes it. People with liver disease should take the same preventive actions being taken by people with other underlying conditions to avoid getting sick with or spreading COVID-19.

COVID-19 vaccination will help protect you from getting COVID-19. Even after you get a COVID-19 vaccine, you should continue to take steps to protect yourself including wearing a mask, staying 6 feet from people who don’t live with you, avoiding crowds and poorly ventilated spaces, and washing your hands often. If soap and water aren’t available, use hand sanitizer containing at least 60% alcohol. The more steps you take, the more you are protected against COVID-19.

Like everyone, people with hepatitis B or hepatitis C should also continue to maintain a healthy lifestyle. If you have hepatitis B or C and are being treated for your infection, it is important to continue your treatment and follow the advice of your healthcare provider. This is the best way to keep you and your immune system healthy. Be sure to keep regular communication with your liver care team and consider telemedicine for appointments when possible.

The best way to avoid COVID-19 is to avoid exposure to the virus that causes it. COVID-19 vaccination will help protect you from getting COVID-19. Even after you get a COVID-19 vaccine, you should continue to take steps to protect yourself, including wearing a mask, staying 6 feet from people who don’t live with you, avoiding crowds and poorly ventilated spaces, and washing your hands often. If soap and water aren’t available, use hand sanitizer containing at least 60% alcohol. The more steps you take, the more you are protected against COVID-19.

People with liver disease should take the same preventive actions being taken by  people with certain other underlying conditions to avoid getting sick with or spreading COVID-19. In addition, people with liver disease and substance use disorder should stay in contact with their healthcare provider and continue prescribed treatments. Learn more about COVID-19 and what you can do to protect yourself if you are a person who uses drugs or has substance use disorder.

Call your healthcare provider if you develop symptoms of COVID-19 or if you have been exposed to someone known to have COVID-19. Discuss how to get evaluated and how to avoid spreading the virus to others.

Learn more about COVID-19 and what to do if you get sick.

People with chronic liver disease should take steps that everyone can take to prevent getting COVID-19. They should also take the same preventive actions being taken by people with other serious underlying medical conditions to avoid getting sick with or spreading COVID-19 including:  wear a mask, stay 6 feet from people who don’t live with you, avoid crowds and poorly ventilated spaces, and wash your hands often. If soap and water aren’t available, use hand sanitizer containing at least 60% alcohol.

In addition to the preventive actions to avoid getting sick with or spreading COVID-19, people with chronic liver disease can also take the following measures:

• If you are currently taking treatment for hepatitis B or C, or other chronic conditions, continue to take your medications as prescribed. Talk to your healthcare provider before stopping any medications prescribed to you. Make sure you have enough of your medication at home to reduce unnecessary visits to health services or pharmacies. You may be eligible for up to a 90-day supply of medication.
• Talk to your healthcare provider about routine vaccination. CDC recommends that people with chronic liver disease receive vaccinations against hepatitis A, hepatitis B, influenza (flu), and pneumococcal disease.
• If you have to stay at home for a couple of weeks, come up with a plan to continue your care. Try to establish a telemedicine link through your hepatitis provider’s online portal. If telemedicine is not available to you, make sure you can communicate with your provider by phone or text.

• Continue to get regular exercise and eat a healthy diet.
• Avoid or minimize alcohol consumption and avoid intoxication. Drinking alcohol does not protect you from COVID-19.

• Make sure you can maintain a social network remotely, such as online, by phone, or by video chat. This can help you stay socially connected and mentally healthy.
• Smoking or vaping tobacco or marijuanaexternal icon could increase your risk of severe respiratory illness. Quitting smoking or vaping may reduce your chances of developing serious complications from COVID-19.
• If you get sick, make sure you stay in touch by phone or email with people who can help you.

At this time, we do not know if or how effective medicines used to treat hepatitis B or C are in treating COVID-19. The Food and Drug Administration (FDA) has approved one drug,  remdesivir, to treat COVID-19.

Researchers are studying new drugs and drugs that are already approved for other health conditions to determine their safety and effectiveness in treating COVID-19. In the meantime, never take a prescription medicine or drug if it is not prescribed for you by your healthcare provider for your health condition.

No drug shortages or anticipated problems with medicine used to treat hepatitis B or C have been identified to date.

The FDA is closely monitoring the drug supply chain because the COVID-19 pandemic has the potential to disrupt the supply of medical and pharmaceutical products in the United States.

Learn more about the FDA’s response to COVID-19external icon and information on drug shortagesexternal icon.

People with chronic liver disease, like others with higher risk for severe COVID-19 illnesspdf icon, should stay at home if possible, and avoid unnecessary travel.

For the latest CDC travel recommendations, visit CDC’s COVID-19 travel information page.

Minimizing stigma and misinformation about COVID-19 is very important. People with liver disease have experience in dealing with stigma and can be allies in preventing COVID-19 stigma. Learn how you can reduce stigma and help prevent the spread of rumors about COVID-19.