A New Endemic of Concomitant Nonalcoholic Fatty Liver Disease and Chronic Hepatitis B

Abstract

Hepatitis B virus (HBV) infection remains a global public problem despite the availability of an effective vaccine. In the past decades, nonalcoholic fatty liver disease (NAFLD) has surpassed HBV as the most common cause of chronic liver disease worldwide. The prevalence of concomitant chronic hepatitis B (CHB) and NAFLD thus reaches endemic proportions in geographic regions where both conditions are common. Patients with CHB and NAFLD are at increased risk of liver disease progression to cirrhosis and hepatocellular carcinoma. Due to the complexity of the pathogenesis, accurate diagnosis of NAFLD in CHB patients can be challenging. Liver biopsy is considered the gold standard for diagnosing and determining disease severity, but it is an invasive procedure with potential complications. There is a growing body of literature on the application of novel noninvasive serum biomarkers and advanced radiological modalities to diagnose and evaluate NAFLD, but most have not been adequately validated, especially for patients with CHB. Currently, there is no approved therapy for NAFLD, although many new agents are in different phases of development. This review provides a summary of the epidemiology, clinical features, diagnosis, and management of the NAFLD and highlights the unmet needs in the areas of CHB and NAFLD coexistence.

Concurrence and impact of hepatic steatosis on chronic hepatitis B patients: a systematic review and meta-analysis

“…Hepatitis B virus (HBV) infection is a significant cause of cirrhosis, hepatocellular carcinoma (HCC), grave morbidity, and mortality (1). Globally, it is estimated that 240 to 350 million of the world's population has hepatitis B (2).…”

The efficacy of antiviral treatment in chronic hepatitis B patients with hepatic steatosis

“…However, according to a recent East Asia expert opinion, liver biopsies for all such patients are unrealistic and may also not distinctly pinpoint the exact cause leading to ALT elevation [ 16 ]. Additionally, there are no specific recommendations for antiviral therapy among exclusively patients with coexisting CHB and NAFLD by current practice guidelines [ 16 , 17 ]. This conundrum poses a dilemma for clinicians regarding the management or treatment initiation of this special population in clinical practice.…”

Gamma‐Glutamyl Transpeptidase‐to‐Platelet ratio predicts liver fibrosis in patients with concomitant chronic hepatitis B and nonalcoholic fatty liver disease

“…Coexistence of NAFLD and CHB is commonly observed in high HBV‐endemic regions. 2 A meta‐analysis reported that the prevalence of hepatic steatosis was about 25%–30% among patients with CHB. 3 Previous studies reported that concomitant presence of HBV and hepatic steatosis is associated with increased risk of disease progression to cirrhosis and hepatic and extrahepatic malignancies, 4 , 5 as Choi et al 6 reported that patients with CHB and nonalcoholic steatohepatitis (NASH) had higher liver‐related outcomes and overall mortality than those with CHB alone.…”

“…With the improvement of living conditions and lifestyle changes, the incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing. Coexistence of NAFLD and CHB is commonly observed in high HBV‐endemic regions 2 . A meta‐analysis reported that the prevalence of hepatic steatosis was about 25%–30% among patients with CHB 3 .…”