Obese patients who often present metabolic dysfunction-associated fatty liver disease (MAFLD) are at risk of severe presentation of coronavirus disease 2019 (COVID-19). These patients are more likely to be hospitalized and receive antiviral agents and other drugs required to treat acute respiratory distress syndrome and systemic inflammation, combat bacterial and fungal superinfections and reverse multi-organ failure. Among these pharmaceuticals, antiretrovirals such as lopinavir/ritonavir and remdesivir, antibiotics and antifungal agents can induce drug-induced liver injury (DILI), whose mechanisms are not always understood. In the present article, we hypothesize that obese COVID-19 patients with MAFLD might be at higher risk for DILI than non-infected healthy individuals or MAFLD patients. These patients present several concomitant factors, which individually can favour DILI: polypharmacy, systemic inflammation at risk of cytokine storm, fatty liver and sometimes nonalcoholic steatohepatitis (NASH) as well as insulin resistance and other diseases linked to obesity. Hence, in obese COVID-19 patients, some drugs might cause more severe (and/or more frequent) DILI, while others might trigger the transition of fatty liver to NASH, or worsen pre-existing steatosis, necroinflammation and fibrosis. We also present the main mechanisms whereby drugs can be more hepatotoxic in MAFLD including impaired activity of xenobiotic-metabolizing enzymes, mitochondrial dysfunction, altered lipid homeostasis and oxidative stress. Although comprehensive investigations are needed to confirm our hypothesis, we believe that the current epidemic of obesity and related metabolic diseases has extensively contributed to increase the number of cases of DILI in COVID-19 patients, which may have participated in presentation severity and death.

经常出现与代谢功能障碍相关的脂肪肝病（MAFLD）的肥胖患者有严重出现2019年冠状病毒病（COVID-19）的风险。这些患者更有可能住院治疗，并接受抗病毒药和其他药物，这些药物和药物可用于治疗急性呼吸窘迫综合征和全身性炎症，抵抗细菌和真菌的超级感染以及逆转多器官衰竭。在这些药物中，抗逆转录病毒药物如lopinavir / ritonavir和remdesivir，抗生素和抗真菌药可以诱导药物诱发的肝损伤（DILI），其机理并不总是被理解。在本文中，我们假设肥胖的COVID-19合并MAFLD患者比未感染的健康个体或MAFLD患者罹患DILI的风险更高。这些患者存在一些伴随因素，这些因素可能会有利于DILI：多药房，面临细胞因子风暴风险的全身性炎症，脂肪肝，有时甚至是非酒精性脂肪性肝炎（NASH）以及胰岛素抵抗和其他与肥胖有关的疾病。因此，在肥胖的COVID-19患者中，某些药物可能会导致更严重（和/或更频繁）的DILI，而另一些药物可能会触发脂肪肝向NASH的转化，或使先前存在的脂肪变性，坏死性炎症和纤维化恶化。我们还介绍了药物可能在MAFLD中更具肝毒性的主要机制，包括异种生物代谢酶的活性受损，线粒体功能障碍，脂质体内稳态改变和氧化应激。尽管需要进行全面调查以确认我们的假设，