Revolutionizing the understanding of liver disease: Metabolism, function and future

Abstract

The intersection between metabolic-associated steatotic liver disease (MASLD) and chronic hepatitis B virus (HBV) infection is an emerging area of research with significant implications for public health and clinical practice. Wang et al's study highlights the complexities of managing patients with concurrent MASLD and HBV. The findings revealed that patients with concurrent MASLD-HBV exhibited more severe liver inflammation and fibrosis, whereas those with HBV alone presented a better lipid profile. The growing recognition of metabolic dysfunction in liver disease, reflected in the shift from nonalcoholic liver disease to MASLD, demands updates to clinical guidelines, particularly for patients with dual etiologies. Understanding the biological interactions between MASLD and HBV could lead to novel therapeutic approaches, emphasizing the need for personalized treatment strategies. The coexistence of MASLD and HBV presents therapeutic challenges, particularly in managing advanced fibrosis and cirrhosis, which are more likely in these patients. The aim of this editorial is to analyze the interaction between MASLD and HBV, highlight the pathophysiological mechanisms that exacerbate liver disease when both conditions coexist, and discuss the clinical implications of the findings of Wang et al.

Keywords: Chronic hepatitis B; Chronic liver disease; Hepatitis B; Hepatitis B virus; Hepatocellular carcinoma; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity; Type 2 diabetes mellitus.

Figure 1

Multifactorial interaction between hepatitis B virus and metabolic-associated fatty liver disease. The complex relationship between chronic hepatitis B virus infection and the manifestations of metabolic-associated fatty liver disease, including a predisposition to hepatic steatosis, insulin resistance, and increased risk of cardiovascular disease, is illustrated. Potential mechanisms involve chronic inflammation, metabolic alterations, and changes in the gut microbiome composition. This figure highlights the importance of considering integrated therapeutic interventions to mitigate the adverse effects of this interaction on hepatic and metabolic health. HBV: Hepatitis B virus; MASLD: Metabolic-associated fatty liver disease; HCC: Hepatocellular carcinoma.