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Review
. 2023 Apr;29(2):320-331.
doi: 10.3350/cmh.2022.0422. Epub 2023 Feb 1.

Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

Shang-Chin Huang  1   2   3   4 , Chun-Jen Liu  2   3   4
Affiliations
Review

Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

Shang-Chin Huang et al. Clin Mol Hepatol. 2023 Apr.

Abstract

The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has increased among the general population and chronic hepatitis B (CHB) patients worldwide. Although fatty liver disease is a well-known risk factor for adverse liver outcomes like cirrhosis and hepatocellular carcinoma, its interactions with the hepatitis B virus (HBV) and clinical impacts seem complex. The presence of hepatic steatosis may suppress HBV viral activity, potentially leading to attenuated liver injury. In contrast, the associated co-morbidities like diabetes mellitus or obesity may increase the risk of developing adverse liver outcomes. These findings implicate that components of MAFLD may have diverse effects on the clinical manifestations of CHB. To this end, a clinical strategy is proposed for managing patients with concurrent CHB and MAFLD. This review article discusses the updated evidence regarding disease prevalence, interactions between steatosis and HBV, clinical impacts, and management strategies, aiming at optimizing holistic health care in the CHB population.

Keywords: Fatty liver; Hepatitis B virus; Hepatocellular carcinoma; Metabolic syndrome; Non-alcoholic fatty liver disease.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Disease definition of MAFLD. The new criteria do not need to exclude patients with other concomitant liver diseases or alcohol intake. MAFLD, metabolic dysfunction-associated fatty liver disease; DM, diabetes mellitus; TG, triglycerides; HDL, high-density lipoprotein; HOMA-IR, Homeostasis Model Assessment-Insulin Resistance index; CRP, C-reactive protein.
Figure 2.
Figure 2.
Proposed mechanism of diverse impacts of steatosis and metabolic dysfunction on clinical outcomes of CHB. The steatosis may suppress the HBV viral activity, leading to fewer liver injuries and fibrosis, and probably a lower risk of HCC. MAFLD, metabolic dysfunction-associated fatty liver disease; CHB, chronic hepatitis B; HCC, hepatocellular carcinoma; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen.
Figure 3.
Figure 3.
Proposed strategies for evaluation and management of CHB patients with concurrent MAFLD. MAFLD, metabolic dysfunction-associated fatty liver disease; CHB, chronic hepatitis B; HBV, hepatitis B virus.
See this image and copyright information in PMC

References

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