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

Chen, Can; Liu, Huan; Huang, Chenyang; Yan, Danying; Zhang, Xiaobao; Zhou, Yuqing; Yu, Lin; Zhou, Yonggang; Guan, Zhou; Ding, Cheng; Lan, Lei; Zhu, Changtai; Wu, Jie; Li, Lanjuan; Yang, Shigui

doi:10.21037/atm-21-3052

Cited by 20 publications

(24 citation statements)

References 34 publications

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“…9 Another meta-analysis demonstrated that concurrent fatty liver was inversely associated with VR (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.48-0.99) and BR (OR, 0.44; 95% CI, 0.28-0.69). 10 However, in a recent retrospective study, the rates of VR and BR were similar between patients with and without NAFLD (86% vs. 88%, 38% vs. 41%, respectively). 12 In our study, NAFLD status changes had no effect on the VR and HBeAg seroconversion.…”

Section: Discussionmentioning

confidence: 86%

“…Some studies have shown that the antiviral efficacy in CHB patients was weakened by concurrent NAFLD. [9][10][11] One study in Korea showed that concurrent NAFLD was associated with a lower VR. 9 Another meta-analysis demonstrated that concurrent fatty liver was inversely associated with VR (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.48-0.99) and BR (OR, 0.44; 95% CI, 0.28-0.69).…”

Section: Discussionmentioning

confidence: 99%

“…In the past, many studies focused on the influence of NAFLD in CHB patients. Concurrent NAFLD is generally considered to promote hepatitis B surface antigen (HBsAg) seroclearance and may inhibit HBV replication, 7,10,11 but its effects on antiviral outcomes, liver fibrosis, and HCC risk remain controversial. Some investigators believed that concurrent NAFLD reduced the rates of biochemical response (BR) and/or virological response (VR) in CHB patients.…”

Section: Introductionmentioning

confidence: 99%

“…Some investigators believed that concurrent NAFLD reduced the rates of biochemical response (BR) and/or virological response (VR) in CHB patients. [9][10][11] Several studies have also showed that fatty liver has no influence on BR and VR. 12,13 However, few studies have reported the impact of NAFLD on the histological response to antiviral therapy.…”

Section: Introductionmentioning

confidence: 99%

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Association between nonalcoholic fatty liver disease status changes and antiviral efficacy in chronic hepatitis B

Tang

Fan

Xie

et al. 2022

Preprint

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Background & Aims: Data on the dynamic changes in chronic hepatitis B (CHB) patients with nonalcoholic fatty liver disease (NAFLD) during antiviral therapy are scarce. To investigate the evolution of concurrent NAFLD in CHB patients treated with nucleos(t)ide analogues (NAs) and its influence on antiviral efficacy. Methods: We enrolled 164 HBeAg-positive CHB patients from a randomized controlled trial who were treated with NAs for 104 weeks and underwent paired liver biopsies. Histological evaluation was performed at baseline and week 104. The patients were divided into four groups according to NAFLD status changes. Results: From baseline to week 104, the overall percentage of CHB patients with concurrent NAFLD increased from 17.1% to 26.2% (P = 0.044). Among them, seven of 28 patients (25.0%) with NAFLD at baseline showed NAFLD remission at week 104, while 22 of 136 patients (16.2%) without NAFLD at baseline developed new-onset NAFLD. In subgroup analyses, the new-onset and sustained NAFLD groups showed significantly lower rates of biochemical response (BR) at week 104 as compared to the sustained non-NAFLD group (77.3% and 55% vs. 93.9%, respectively; all P < 0.05), as well as fibrosis improvement (31.8% and 45.0% vs. 69.3%, respectively; all P < 0.05). NAFLD status changes did not influence the virological response, HBeAg seroconversion, and necroinflammation improvement (all P > 0.05). Conclusions: In HBeAg-positive CHB patients receiving NAs therapy, new-onset and sustained NAFLD may counteract the benefits of antiviral therapy, reducing the rate of BR and fibrosis improvement.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between nonalcoholic fatty liver disease status changes and antiviral efficacy in chronic hepatitis B

Tang

Fan

Xie

et al. 2022

Preprint

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“…Meanwhile, chronic hepatitis B (CHB) infection was a leading cause of liver-related morbidity and mortality affecting more than 296 million individuals worldwide in 2019 ( 3 ). The global prevalence of hepatic steatosis (HS) in CHB patients was estimated to be 34.94% [95% confidence internal (CI): 32.01–37.9%] ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Effect modification of hepatitis B viral load on the association between metabolic risk factors and hepatic steatosis

Shi¹,

Wong²,

Lee³

2023

Transl Gastroenterol Hepatol

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Background: It is not clear if chronic hepatitis B (CHB) infection potentiates the severity of hepatic steatosis (HS) in patients with metabolic risk factors. We tested for the effect modification of hepatitis B viral load on the association between metabolic risk factors and HS.Methods: In this retrospective cross-sectional study, we included adult subjects, who had non-cirrhotic nonalcoholic fatty liver disease and CHB infection with positive hepatitis B envelope antibody. We reported descriptive statistics, stratified by detectable and undetectable hepatitis B viral load, by Kruskal-Wallis Rank Sum Test and chi-square. We reported coefficients of two multivariate regression predicting odds of HS > stage 2, testing for interaction between metabolic risk factors and hepatitis B viral load. Results: When controlled for age, sex, and hepatitis B treatment, the odds of HS > stage 2 increased significantly by 77% for each additional metabolic risk factor [odds ratio (OR) 1.77, 95% confidence interval (CI): 1.20-2.69, P=0.005]. The odds of HS > stage 2 was not associated with detectable hepatitis B viral load (OR 1.00, 95% CI: 0.83-1.19, P=0.986). The association between the odds of HS > stage 2 and metabolic risk factors did not significantly change as hepatitis B viral load increased [ratio of odds ratio (ROR) 1.01, 95% CI: 0.94-1.08, P=0.839]. Conclusions: Our study does not find evidence of effect modification of hepatitis B viral load on the association between metabolic risk factors and HS in non-cirrhotic and hepatitis B envelope antibody positive patients with CHB viral infection. It suggests that the odds of HS in CHB infected patients is affected by metabolic risk factors and not by hepatitis B viremia.

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Geographical similarity and differences in the burden and genetic predisposition of NAFLD

et al. 2022

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NAFLD has become a major public health problem for more than 2 decades with a growing prevalence in parallel with the epidemic of obesity and type 2 diabetes (T2D). The disease burden of NAFLD differs across geographical regions and ethnicities. Variations in prevalence of metabolic diseases, extent of urban–rural divide, dietary habits, lifestyles, and the prevalence of NAFLD risk and protective alleles can contribute to such differences. The rise in NAFLD has led to a remarkable increase in the number of cases of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and liver‐related mortality related to NAFLD. Moreover, NAFLD is associated with multiple extrahepatic manifestations. Most of them are risk factors for the progression of liver fibrosis and thus worsen the prognosis of NAFLD. All these comorbidities and complications affect the quality of life in subjects with NAFLD. Given the huge and growing size of the population with NAFLD, it is expected that patients, healthcare systems, and the economy will suffer from the ongoing burden related to NAFLD. In this review, we examine the disease burden of NAFLD across geographical areas and ethnicities, together with the distribution of some well‐known genetic variants for NAFLD. We also describe some special populations including patients with T2D, lean patients, the pediatric population, and patients with concomitant liver diseases. We discuss extrahepatic outcomes, patient‐reported outcomes, and economic burden related to NAFLD.

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

Cited by 20 publications

References 34 publications

Association between nonalcoholic fatty liver disease status changes and antiviral efficacy in chronic hepatitis B

Association between nonalcoholic fatty liver disease status changes and antiviral efficacy in chronic hepatitis B

Effect modification of hepatitis B viral load on the association between metabolic risk factors and hepatic steatosis

Geographical similarity and differences in the burden and genetic predisposition of NAFLD

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