| Popis: |
Background and Aims: Clinical course of Covid-19 is not yet established in autoimmune hepatitis (AIH). About 25% of our 400 AIH-outpatients from various states in Brazil are using hydrochloroquine (HCQ) for maintenance or treatment with corticosteroids and immunosuppressants (IS). The aim is to describe the clinical features and outcomes of COVID-19 in patients with AIH. Methods: The diagnosis of COVID was confirmed by positive PCR of nasal swab and/or by serological tests. The diagnosis and treatment of COVID was not always made in our service. Results: 33 patients, 85% female, 41±13yr; 88% AIH-1; 54.6% with advanced fibrosis (F3/F4); 81.8% with comorbidities (17 overweight/obesity [BMI 31.8±5.4], 10 arterial hypertension, 8 diabetes, 2 systemic lupus erythematosus [SLE, with renal failure], 1 celiac disease and malnutrition). The most frequent symptoms were cough (20), headache (19), anosmia and myalgia (18), diarrhea (17) and dyspnea (11). IS at infection was 14 azathioprine(AZA)+prednisone(PD), 2 AZA+PD+cyclosporine, 3 Mycophenolate+PD. HCQ was used for maintenance (6) or as a complement of IS (5). Five hospitalized patients received oxygen supplementation (1 endotracheal intubation); 1 was pregnant and 1 received methylprednisolone pulse+immunoglobulin to treat SLE immediately before COVID; 3 were under double IS and 2 HCQ. 23 received antibiotics (19 azithromycin). In 10 patients (9 with normal liver enzymes before COVID) there were IS adjustments: IS withdrawal and increase of PD dosage (6), increase PD dosage (2), IS withdrawal and HCQ prescription (1), AZA withdrawal+decrease PD dose (1). Six of the 10 patients had slight increase of liver enzymes, none liver decompensation. One patient died, with celiac disease who acquired COVID during hospitalization for lymphoma investigation. Conclusions: It appears that patients under IS for AIH and COVID-19 show outcomes similar to that of non-immunosuppressed population. HCQ does not appear to have a positive impact on preventing or progressing the disease. |
