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. 2024 Dec 27;16(12):1429-1440.
doi: 10.4254/wjh.v16.i12.1429.

Clinical profiles and their interaction of concurrent metabolic associated steatotic liver disease and hepatitis B virus infection

Shao-Wen Wang  1 , Yu-Wen Chang  2 , Ching Wang  3 , Yu-Ming Cheng  4 , Tsung-Han Hsieh  5 , Chia-Chi Wang  6 , Jia-Horng Kao  7
Affiliations

Clinical profiles and their interaction of concurrent metabolic associated steatotic liver disease and hepatitis B virus infection

Shao-Wen Wang et al. World J Hepatol. .

Abstract

Background: A new nomenclature of metabolic associated steatotic liver disease (MASLD) was proposed in 2023, thus expanding the diagnostic name of "MASLD combined with other etiologies".

Aim: To investigate the clinical profiles of patients with concurrent MASLD and chronic hepatitis B virus (HBV) infection.

Methods: This study included participants from the Taiwan Bio-bank. The diagnostic criteria of MASLD encompassed hepatic steatosis and any cardio-metabolic risk factors. Positive hepatitis B surface antigen was considered indicative of chronic HBV infection. Dual etiology was defined as MASLD combined with chronic HBV infection (MASLD-HBV). Fibrosis 4 (FIB-4) score determined the severity of liver fibrosis, and atherosclerosis was diagnosed by the presence of carotid plaques on duplex ultrasound.

Results: In a total of 18980 participants (mean age, 55.18 ± 10.35 years; males, 30.42%), there were 7654 (40.3%) MASLD patients and 2128 (11.2%) HBV carriers. After propensity score matching for age and gender, HBV carriers had a lower percentage of MASLD than healthy controls. Those with dual etiology had higher aspartate aminotransferase, alanine aminotransferase (ALT), and FIB-4 levels, but lower gamma glutamyl transferase (GGT) levels than MASLD patients. In contrast, those with dual etiology had higher ALT and GGT levels, but lower FIB-4 than "HBV alone" patients. The risk of atherosclerosis was similar among these three groups.

Conclusion: MASLD-HBV patients have worse liver fibrosis severity than MASLD patients, but better liver fibrosis stage than "HBV alone" patients, suggesting a complex interaction between MASLD and chronic HBV infection.

Keywords: Atherosclerosis; Fibrosis 4 score; Hepatitis B virus; Metabolic dysfunction; Non-alcoholic fatty liver disease; Steatotic liver disease.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Patients were distributed to three groups according to the results of hepatitis B surface antigen and hepatitis B core antibodies. anti-HBc: Hepatitis B core antibodies; anti-HCV: Antibodies against hepatitis C virus; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus.
Figure 2
Figure 2
Metabolic associated steatotic liver disease patients were distributed to two groups based on the status of hepatitis B surface antigen. HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; MASLD: Metabolic dysfunction-associated steatotic liver disease.
Figure 3
Figure 3
Patients with positive hepatitis B surface antigen were distributed to two groups based on the status of metabolic dysfunction-associated steatotic liver disease. anti-HBc: Hepatitis B core antibodies; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; MASLD: Metabolic dysfunction-associated steatotic liver disease.
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