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COVID And Monkeypox

COVID and monkeypox are frequent topics of conversation. Many questions remain regarding what these infections can cause. This column will discuss the current knowledge of these infections on the liver.

COVID infections remain common in our area with the number of actual cases being much higher than the reported cases due to the widespread availability of home testing. The dominant strain in the U.S. is BA.5 and this is reported to be the most contagious of all the COVID strains to date. Super-spreading events are up as people seem to be more comfortable attending these events without masking. While infections are up, hospitalizations and severe outcomes from this strain are down, which is good news. Widespread vaccination and boosters, while not eliminating the risk of acquiring COVID, can be credited for lessening the impact of the disease on those infected.

When COVID was first described, the data showed the fifty percent of infected individuals developed abnormal liver tests and some developed chronic liver disease with some even requiring liver transplantation. This does not appear to be the case with the newer strains. Whether this is a vaccine effect or that this strain is less liver toxic is unknown. It may simply be that the majority of COVID infected patients

THE SPECIALIST

David Bernstein, MD

currently stay at home and do not go for laboratory testing while in the beginning of the pandemic, these patients were seen in the hospitals and labs were obtained. Regardless, this is good news for the liver.

When people with liver disease become infected with COVID, they do not have worse outcomes than those without liver disease. A recent report described no increased risk of poor outcomes in people with fatty liver and since this is about thirty percent of the American population, this comes as good news. For people with cirrhosis, COVID is associated with poor outcomes so it is essential that this group be vaccinated, take boosters when available and consider masking when entering indoor public places.

Treatments are available for COVID although most patients can recover without these therapies. Monoclonal antibodies are widely used and have been shown to be safe for liver patients and not to cause abnormal liver tests when given to the general population. Paxlovid, however, due to its ritonavir component, has been described to cause abnormal liver tests and therefore should be given with caution in patients with underlying chronic liver disease.

Monkeypox is a virus that is similar to smallpox and is not related to chickenpox. It is typically spread through close personal and intimate contact and is more commonly spread in men having sex with men. Monkeypox typically causes fever, headaches, muscle aches, a lack of energy and a rash resembling pimples or pus-filled blisters. Monkeypox is rarely fatal and significant liver issues have not been reported to be associated with this infection. There is no specific treatment. A vaccine is available to prevent infection. —David Bernstein, MD, MACG, FAASLD, AGAF, FACP

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