Hepatitis B is a viral infection that affects the liver. It’s caused by the hepatitis B virus. In most people, the body will clear the infection on its own after several weeks.

But sometimes, hepatitis B can become chronic, or long-term. Over time, this can cause severe complications like cirrhosis, or liver scarring, and end stage liver disease (ESLD).

If you have hepatitis B, you might have a higher risk of having a more severe infection from the SARS-CoV-2 virus. This is the virus that causes COVID-19, a respiratory disease.

Also, hepatitis B presents additional risks when it comes to COVID-19 treatment.

Read on to learn about the link between hepatitis and COVID-19, as well as what you should know if you have the liver condition.

Generally, people with underlying medical conditions are more likely to get COVID-19. This includes liver diseases like hepatitis B.

The risk is higher if you:

  • have severe, chronic hepatitis B
  • have chronic hepatitis B alongside cirrhosis or liver cancer
  • are 65 or older
  • have other medical conditions, like heart disease, obesity, or diabetes

A 2020 case report states that COVID-19 may target the liver. And according to a 2022 research editorial, people with atypical liver function are at a higher risk of getting sicker from COVID-19.

The current evidence linking hepatitis B and severe COVID-19 is mixed. It may depend on the severity of hepatitis B itself.

For example, a 2021 study found that hepatitis B is not associated with severe COVID-19. A 2019 review also notes that people with hepatitis B are unlikely to develop severe COVID-19.

The exception is if they have ESLD, which includes cirrhosis. The authors clarified that more research is needed to determine the risk of severe disease in those with chronic hepatitis B.

That said, a large 2020 study found that people with liver disease have a higher risk of hospitalization or death due to COVID-19. The risk is even higher when cirrhosis is present.

Similarly, another 2020 study found that cirrhosis increases the risk of death due to COVID-19.

There are several explanations behind this link. According to the 2020 study above, COVID-19 causes severe inflammation, which can affect the liver. This may worsen liver function, resulting in ESLD.

Another 2019 scientific review notes that the immune function may play a role. Poor immune function caused by liver disease can increase the risk of severe COVID-19.

Additionally, people with hepatitis B are more likely to develop COVID-19 if they’re 65 or older and have other medical conditions.

According to a 2022 review, there’s no evidence suggesting that previously having hepatitis B that has self-resolved without permanent liver damage poses a risk for severe COVID-19.

There’s also no evidence that previous hepatitis B increases the risk of liver damage due to COVID-19.

A hepatitis B flare-up occurs when the virus is reactivated. It might involve:

  • reappearance of virus particles after hepatitis B has resolved
  • increase in virus particles in inactive chronic hepatitis B

It’s possible for COVID-19 to reactivate hepatitis B. That’s because COVID-19 might target the liver, according to a 2020 case report. In some people, this may trigger a hepatitis B flare-up.

But the impact of COVID-19 on hepatitis B flare-ups is unknown. The current research has found conflicting results.

For example, in a small 2020 study, people with COVID-19 and hepatitis B experienced no severe liver complications.

Another 2020 study found no evidence that having both conditions worsen liver problems. Alternatively, a 2021 study reports that COVID-19 can worsen liver function in people with hepatitis B.

There’s more conclusive research on COVID-19 medication and hepatitis B. Specifically, immunosuppressive drugs used to treat COVID-19 may reactivate the condition. These include:

According to a 2022 review, the immune response is involved in both liver inflammation and replication of viruses. As the above treatments suppress the immune system, the replication of hepatitis B viruses increases. This causes a hepatitis B flare-up.

Also, medications like corticosteroids can cause hepatoxicity, or liver damage. This can increase the risk of hepatitis B reactivation.

If you have severe hepatitis B or cirrhosis, you may need to take extra precautions against COVID-19.

This includes taking your prescription medication and attending medical appointments as usual. Additionally, you may need more frequent hepatitis B testing and lab monitoring if you get COVID-19.

You should also follow the preventive measures recommended for everyone:

  • Wear a well-fitting mask.
  • Avoid crowds as much as possible.
  • Avoid poorly ventilated spaces.
  • Wash your hands frequently.
  • Clean frequently touched surfaces.

The COVID-19 vaccine is considered safe for people with hepatitis B.

According to 2022 study, people with hepatitis B experience the same side effects as those without hepatitis B.

The side effects are also mild and self-limiting, meaning they went away on their own. Examples include:

  • pain and swelling at injection site
  • fatigue
  • muscle pain
  • fever
  • chills
  • dizziness

The Global Hepatology Society also recommends the vaccine for people with liver disease.

According to the 2022 study above, the COVID-19 vaccine causes the appropriate antibody response in people with hepatitis B. Thus, the vaccine is considered to be effective if you have the condition.

If you have hepatitis B, you should get the COVID-19 vaccine. That’s because medical conditions, including liver diseases, increase your risk of severe COVID-19 symptoms.

It’s especially important to get vaccinated if you’re 65 or older and have other medical conditions. These factors further increase your risk of severe illness from COVID-19.

Like the general population, you should avoid getting the vaccine if you:

  • are allergic to any of the ingredients in the COVID-19 vaccine
  • have a fever on the day of your vaccine appointment
  • have confirmed or suspected COVID-19 on the day of your vaccine appointment

Your doctor is the best person to determine if you should get the vaccine.

In severe cases, COVID-19 is treated with immunosuppressants. But since these medications can reactivate hepatitis B, additional precautions are necessary.

People with hepatitis B require antiviral prophylaxis when taking immunosuppressants. This involves taking antiviral medications, which are designed to reduce the risk of viral reactivation.

You might need to continue taking these medications for 6 to 12 months after finishing immunosuppressive therapy.

Hepatitis B, like other medical conditions, can increase your risk of getting COVID-19. You might also be more likely to develop severe illness from COVID-19 if you have cirrhosis due to hepatitis B.

However, severe COVID-19 is often treated with immunosuppressants. These drugs can reactivate or worsen hepatitis B. In this case, you’ll need to take antiviral medications in addition to immunosuppressants.

The COVID-19 vaccine is safe and effective for people with hepatitis B. It’s recommended to get the vaccine unless you’re allergic to the ingredients or currently have COVID-19.