Benign course of hepatitis A and COVID-19 coinfection: A retrospective observational case series with comparative analysis.

Background: In regions where hepatitis A virus (HAV) is endemic, the COVID-19 pandemic has introduced new challenges. While liver involvement in SARS-CoV-2 is well documented, the impact of HAV-COVID-19 coinfection remains unclear. Objective: Evaluate whether COVID-19 coinfection worsens clinical outcomes or liver injury in patients with HAV infection. Methods: We conducted a retrospective observational study at a tertiary care hospital in Lebanon, including 15 patients with confirmed HAV infection: 7 individuals were infected with COVID-19 (HAV-COVID coinfection group) and 8 with HAV alone (HAV-only group). Clinical characteristics, liver function tests, inflammatory markers, and recovery trends were assessed at admission (Day 1) and follow-up (Day 10) and remote follow-up extended up to 30 days. Group comparisons were made using Mann-Whitney U tests with effect sizes reported as rank-biserial correlations. Results: All patients experienced a mild disease course without hepatic complications or ICU admissions. CRP levels were significantly higher in the HAV-COVID group at both time points (Day 1 p = 0.04; Day 10 p < 0.001), but no statistically significant differences were seen in liver enzymes or recovery rates between the groups. Conclusion: HAV-COVID-19 coinfection in otherwise healthy individuals does not appear to worsen liver injury or delay recovery compared to HAV alone. However, given isolated reports of fulminant hepatitis, clinicians should continue to screen for coinfection in patients presenting with liver injury during with COVID-19, especially in HAV-endemic regions. Larger studies are needed to confirm these findings and explore potential risk modifiers.