JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
347
347
CLINICAL MANIFESTATIONS IN COVID-19 WITH HDV INFECTION
Аrashova Gulnora Amirkulovna
Bukhara State Medical Institute named after
Abu Ali ibn Sina, Bukhara c., Uzbekistan.
E-mail: arashova.gulnora@bsmi.uz
https://orcid.org/0009-0009-0643-3775
Annotation:
In the context of liver involvement in patients with COVID-19, many
key aspects need to be addressed in both native and transplanted organs. This review
focuses on the clinical presentations and laboratory abnormalities of liver function tests
in patients with COVID-19 with no prior liver disease, patients with pre-existing liver
diseases and liver transplant recipients. A brief overview of the history of COVID-19
and etiopathogenesis of the liver injury will also be described as a prelude to better
understanding the above aspects.
Keywords:
COVID-19, liver injury, SARS-CoV-2, clinical manifestations, liver
function tests, cirrhosis
Relevance
Many patients with severe disease may die from multiorgan failure. In this review,
we described liver involvement in COVID-19, which can be studied from many
aspects. The focus of this review, however, was on clinical and laboratory
manifestations of liver disease in COVID-19 patients, in the native healthy liver, native
diseased liver and in the transplanted liver.In the Republic of Uzbekistan, the
introduction of the HBV vaccination into the preventive vaccination schedule has
resulted in nearly a 40-fold reduction in cases. However, despite effective measures,
the number of mixed HBV infections identified with the delta agent is increasing, and
Uzbekistan remains one of the countries with moderate endemicity on the global map
[4].
In the literature reviewed, we did not find information regarding the course of
COVID-19 infection against the background of chronic HDV infection. Therefore, the
aim of this study was to determine the clinical and laboratory characteristics of
COVID-19 infection in the context of HDV infection.
“Livomed” tablets, a well-balanced combination of pure herbs, is a very useful
remedy for jaundice, liver enlargement and cirrhosis, loss of appetite, anemia,
alcoholism, etc. It protects the liver from various hepatotoxins, corrects liver
dysfunction and damage. Promotes appetite and controls jaundice. It helps the liver
eliminate toxins and restore cell growth while protecting them from the harmful effects
of alcohol, drugs and environmental toxins. Restores the functional efficiency of the
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
348
348
liver by protecting the liver parenchyma and promoting liver cell regeneration. Its
antiperoxidant activity prevents the loss of functional integrity of the cell membrane,
supports and ensures early restoration of liver function in infectious hepatitis.
Materials and methods.
A total of 143 patients with HDV+COVID-19 infection
and 50 patients with only COVID-19 infection, treated at the Zangiota Specialized
Hospital from 2021 to 2023, were selected using a randomized method. The main
clinical signs of the disease and a comparative analysis of certain laboratory indicators
were conducted for these patients.
Inclusion criteria for the study: Patient consent to participate in the study. Male or
female patients aged 18 years and older. Patients with confirmed COVID-19 and HDV
infection by PCR.
Exclusion criteria for the study: Pregnant or lactating women. Non-compliance
with the requirements and procedures of the study. Patients younger than 18 years.
Patients with chronic somatic, oncological, or hematological diseases.
Specific IgM and IgG for chronic viral hepatitis B and D were determined in
serum by the IFT method, along with D-dimer, C-reactive protein, and interleukin-6
(IL-6). The test kits developed by HUMAN (Germany) and NPO "Diagnostic Systems"
(Nizhny Novgorod, Russia) were used for this purpose. The quantity of viral hepatitis
B DNA and D RNA in the serum was determined by the PCR method, using test kits
developed by InterLabServis (Moscow, Russia) and Vektor-Best (Novosibirsk,
Russia).
Results.
In the course of the study, we observed 120 patients who received
treatment at Zangiota Specialized Hospital No. 2 between 2021 and 2023, and 43 of
them were found to have HDV infection, representing 1.1% of the total number of
patients studied. Accordingly, we divided the patients into two groups: the main group,
consisting of 43 patients with HDV+COVID-19 infection, and the comparison group,
which included 50 patients with COVID-19 infection only. Among patients in the main
group with HDV+COVID-19 infection, 26 (60.5%) were women and 17 (39.5%) were
men. In the comparison group, 62.0% (31) of the patients were women and 38.0% (19)
were men. The average age of patients in the main group was 41.6±2.1 years, while in
the comparison group, it was 38.9±1.7 years. As can be seen, there were no significant
differences between the groups in terms of age (p=0.987622) or gender (OR=1.8;
CI=0.9-3.1; χ2=0.328), meaning the groups were comparable.
Among the 93 patients in the study group, 15 (16.1%) had a mild course of
COVID-19, 51 (54.8%) had a moderate course, and 27 (29.0%) had a severe course. In
the main group of patients with COVID-19 on the background of HDV infection, mild
cases of the disease were observed less frequently compared to patients in the
comparison group, and the difference between the groups was statistically significant
(OR=5.7; CI=1.5-21.4; p<0.05 by Fisher's exact test). In the study group, the
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
349
349
probability of moderate and severe COVID-19 courses was nearly the same, with no
statistically significant differences between the groups.
Results.
This finding is significant as it aligns with existing research that
highlights sex differences in immune responses and disease outcomes, particularly in
infections like COVID-19 [15].
Patients in the main group exhibited more pronounced signs of intoxication, such
as headache, dizziness, and respiratory symptoms. Dyspeptic symptoms (nausea,
vomiting) were significantly more common in the HDV+COVID-19 group,
highlighting the gastrointestinal impact of HDV infection. The frequency of jaundice
and hepatosplenomegaly was also notably higher in the HDV+COVID-19 group,
indicating a more severe effect on liver function. According to diarrhea and loss of
appetite are also reported, with gastrointestinal symptoms linked to increased severity
of COVID-19 [16]. The combination of HDV and COVID-19 exacerbates liver
damage, leading to higher rates of jaundice and hepatosplenomegaly [17]
Conversely, some studies suggest that gastrointestinal symptoms may correlate
with milder COVID-19 outcomes, indicating a complex relationship between these
symptoms and disease severity(Canakis et al., 2022).
Mild cases of COVID-19 were less frequent in the HDV+COVID-19 group
compared to the COVID-19-only group, indicating that HDV infection may contribute
to a more severe disease course. Among patients with moderate and severe forms of
the disease, there were no significant differences between the two groups, suggesting
that while HDV co-infection affects the incidence of mild cases, it does not appear to
impact the distribution of moderate and severe cases.
Conclusion
In conclusion, liver involvement is common in patients with COVID-19 infection,
particularly in those with moderate to severe disease. It is mostly asymptomatic or mild
in nature. Conversely, patients with pre-existing liver disease are prone to serious
COVID-19. Data on the impact of COVID-19 infection on patients with pre-existing
diseases or liver transplants is either conflicting or scarce. Hence, large collaborative
studies with prolonged follow-up are needed to fully comprehend the impact of this
challenging infection on patients with liver diseases.
References:
1.Atabekov, N.S., Norboev, K.H., Anvarova, L.U. Epidemic struggle against
COVID-19 in Uzbekistan and epidemiological analysis of the disease in organized
groups // Tashkent Medical Academy Bulletin. – Tashkent, 2022. - No. 5. - P. 15-
19.Gao YD, Ding M, Dong X, Zhang JJ, Azkur AK, Azkur D, et al. Risk factors for
severe and critically ill COVID-19 patients: A review. Allergy. 2020; 76: 428-55.
2.Grabowski J., Wedemeyer H. Hepatitis delta: immunopathogenesis and clinical
challen //GES. Dig Dis, 2010. Vol. 28. –P. 133–138.
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
350
350
3. Gulnora A. Arashova.A Clinical Analysis of Measles Outbreak and
Immunization Gaps Journal of Angiotherapy 8(6) 1-6 https://doi.org/10.25163/
angiotherapy. 869754
4. Арашова Гулнора Амиркуловна Паразитарные Заболевания - Актуальная
Проблема Современной Медицины.Журнал науки в медицине и жизни. Выпуск
2 № 3 (2024), стр 4-8 https://journals. proindex. uz/index. php/JSML/ article/view/
693
5.Jalilova A.S. (2022). FEATURES OF CLINICAL MANIFESTATIONS OF
CYTOMEGALOVIRUS INFECTION IN CHILDREN.
International Journal of
Medical
Sciences
And
Clinical
Research
,
2
(09),
12–16.
https://doi.org/10.37547/ijmscr/Volume02Issue09-04
6. Г.А.Арашова. Клинические особенности течения ветряной оспы на
современном этапе. Вестник ТМА № 3/2, 2023
7. Aslonova M. R. (2023). IFN-α STATUS IN PATIENTS WITH SARS-CoV-2
AND TYPE 2 DIABETES. Proceedings of International Conference on Modern
Science
and
Scientific
Studies, 2(10),
23–24.
Retrieved
from
https://econferenceseries.com/index.php/icmsss/article/view/2795
8. Арашова Г.А. Клинико-эпидемиологические особенности кори у
взрослых. 2022. //Журнал«Инфекция, иммунитет и фармакология», специальный
выпуск. 2022;1(2):12-17.
9. Mukhammadieva M.I. (2023). Вирус этиологияли жигар циррози
беморларида спонтан бактериал перитонит билан асоратланишнинг
профилактикаси ва давосини такомиллаштириш//Oriental Renaissance:
Innovative, educational, natural and social sciences. -2023.-P.947-953.
10. Mukhammadieva Musharraf Ibrokhimovna. (2023). IMPROVING THE
PREVENTION AND TREATMENT OF COMPLICATIONS OF SPONTANEOUS
BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS OF VIRAL
ETIOLOGY.
Galaxy International Interdisciplinary Research Journal
,
11
(4), 388–
394. Retrieved from https://giirj.com/index.php/giirj/article/view/5168
11. Mukhammadieva M. I. Improvement of primary prevention and treatment of
complications with spontaneous bacterial peritonitis in patients with liver cirrhosis of
viral etiology //Тиббиётда янги кун.-2023-9 (59). – 2023. – С. 247-252.
12.Mukhammadieva M.I. (2022). Modern clinical and biochemical
characteristics of
liver cirrhosis patients of viral etiology with spontaneous bacterial peritonitis
//Texas Journal of Medical Science. – 2022.- P. 86-90
13.Mukhammadieva M.I. (2023). Вирус этиологияли жигар циррози
беморларида спонтан бактериал перитонит билан асоратланишнинг
профилактикаси ва давосини такомиллаштириш//Oriental Renaissance:
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
351
351
Innovative, educational, natural and social sciences. -2023.-P.947-953.
14.Oblokulov A.R., M.I.Mukhammadieva.(2022). Clinical and biochemical
characteristics of liver cirrhosis patients of viral etiology with spontaneous bacterial
peritonitis//Academicia Globe: Indersciense Research.-2022.- P. 210-216.
15. Arashova G.A Observation of the Immuno-Pathogenetic State of Measles in
Adults.//International journal of health systems and medical sciences. 2022;1(5).
16. Mukhammadieva Musharraf Ibrokhimovna. (2023). IMPROVING THE
PREVENTION AND TREATMENT OF COMPLICATIONS OF SPONTANEOUS
BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS OF VIRAL
ETIOLOGY.
Galaxy International Interdisciplinary Research Journal
,
11
(4), 388–
394. Retrieved from https://giirj.com/index.php/giirj/article/view/5168
17. Sanokulova Sitora Avazovna. (2023). Acute Kidney Injury in Critically Ill
Cirrhotic Patients with Spontaneous Bacterial Peritonitis. Texas Journal of Medical
Science,
25,
65–70.
Retrieved
from
https://zienjournals.com/index.php/tjms/article/view/4502
18. Arashova G.A. Helmintises - An Current Problem of Modern Medicine
AMERICAN Journal of Pediatric Medicine and Health Sciences. Volume 02, Issue
02,2024 PAGES: 402-406
19.Санокулова,
Ситора
Авазовна
ОCOБЕННОСТИ
ТЕЧЕНИЯ
КОНТОГИОЗНЫХ
ГЕЛЬМИНТОВ
АССОЦИИРОВАННОГО
С
ЛЯМБЛИОЗОМ
//
ORIENSS.
2023.
№2.
URL:
https://cyberleninka.ru/article/n/ocobennosti-techeniya-kontogioznyh-gelmintov-
assotsiirovannogo-s-lyambliozom (дата обращения: 12.12.2023).
20. Jalilova, А.S. (2022). THE SPREAD OF CIRRHOSIS OF THE LIVER BY
ETIOLOGICAL FACTORS. Oriental renaissance: Innovative, educational, natural
and social sciences, 2 (6), 253-257.\
21. Aslonova Marjona Ramazonovna. (2023). IFN-γ STATUS IN PATIENTS
WITH SARS-CoV-2 AND TYPE 2 DIABETES.
Proceedings of Scientific Conference
on
Multidisciplinary
Studies
,
2
(11),
5–6.
Retrieved
from
https://econferenceseries.com/index.php/scms/article/view/2799
22.
Облоқулов, А., & Муҳаммадиева, М. (2022). КЛИНИКО-
ЛАБОРАТОРНАЯ
ХАРАКТЕРИСТИКА
СПОНТАННОГО
БАКТЕРИАЛЬНОГО ПЕРИТОНИТА ПРИ ЦИРРОЗЕ ПЕЧЕНИ ВИРУСНОЙ
ЭТИОЛОГИИИ. Журнал
вестник
врача, 1(3),
66–69.
извлечено
от
https://inlibrary.uz/index.php/doctors_herald/article/view/2016
23. Arashova G.A Observation of the Immuno-Pathogenetic State of Measles in
Adults.//International journal of health systems and medical sciences. 2022;1(5).
24. Aslonova.M.R. (2022). Determination of suicidality against the background
of Parasitic Diseases in children // INTERNATIONAL JOURNAL OF
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–79_Issue-1_June-2025
352
352
PHILOSOPHICAL STUDIES AND SOCIAL SCIENCES. – 2022.- P. 9-12.
25. Abdulloyevna, M. S. . (2023). Tez-Tez Kasal Bo’lgan Bolalarda O’tkir
Respirator Kasalliklarning Klinik-Laboratoriya Xususiyatlari. AMALIY VA
TIBBIYOT FANLARI ILMIY JURNALI, 2(12), 29–34. Retrieved from
https://sciencebox.uz/index.php/amaltibbiyot/article/view/8680
26. Aslonova Marjona Ramazonova. (2023). Correlation Relationship of
Interferons, Cytokines with Biochemical Mediators of Inflammation in The Blood in
The Association of Covid-19 and Type 2 Diabetes.
Texas Journal of Medical
Science
,
26
, 70–77. https://doi.org/10.62480/tjms.2023.vol26.pp70-77
27. Mukhtarova, S. H. (2022). A.(2022) AGE-RELATED FEATURES OF
CLINICAL MANIFESTATIONS OF GIARDIASIS. INTERNATIONAL JOURNAL
OF MEDICAL SCIENCES AND CLINICAL RESEARCH, 17-21.
28. Aslonova.M.R. (2023). VITAMIN DEFICIENCY CASES RESULTING
FROM PARASITIC DISEASES // Galaxy International Interdisciplinary Research
Journal.-2023.-P. 404-409
29. Mukhtorova Shokhida Abdulloevna. (2023). CHARACTERISTIC
FEATURES OF THE COURSE OF CITOMEGALOVIRUS INFECTION IN
CHILDREN. Galaxy International Interdisciplinary Research Journal, 11(4), 484–487.
Retrieved from https://giirj.com/index.php/giirj/article/view/5150..
30. Ш. А, М. (2023). Профилактика Сезонного Распространения Орви Среди
Детей Раннего Возраста. AMALIY VA TIBBIYOT FANLARI ILMIY JURNALI,
2(12),
22–28.
Retrieved
from
https://www.sciencebox.uz/index.php/amaltibbiyot/article/view/8678
31. Mukhammadieva M. I. Improving the prevention and treatment of
complications of spontaneous bacterial peritonitis in patients with liver cirrhosis of
viral etiology //Galaxy international interdisciplinary research journal. – 2023. – Т. 11.
– №. 04.
32. Arashova G.A. Modern Methods of Combating Infectious Diseases
AMERICAN Journal of Pediatric Medicine and Health Sciences Volume 01, Issue 10,
2023 ISSN E): 2993-2149 pages 70-75
