Highlights
- •Hepatic steatosis was associated with a 3-fold increase in likelihood of HBsAg seroclearance in quiescent CHB infection.
- •Cumulative probability of HBsAg seroclearance at 3 years was 18.4% in those with steatosis and low serum HBV DNA (<200 IU/ml).
- •Fibrosis progression was still observed in 25.2% patients despite virological quiescence.
- •Persistent severe hepatic steatosis was associated with a 2-fold increased risk of fibrosis progression at 36 months.
- •Routine CAP measurement in patients with apparently low-risk CHB has prognostic value.
Background & Aims
Concomitant non-alcoholic fatty liver disease is common in patients with chronic hepatitis
B (CHB) infection, although its impact on liver-related outcomes remains controversial.
We aimed to study the effect of hepatic steatosis on the risk of fibrosis progression
and the likelihood of HBsAg seroclearance.
Methods
Treatment-naïve patients with CHB, normal alanine aminotransferase and low viraemia
(serum HBV DNA <2,000 IU/ml) were prospectively recruited for baseline and 3-year
transient elastography assessment. Fibrosis staging was defined according to the EASL-ALEH
guidelines, with fibrosis progression defined as ≥1 stage increment of fibrosis. Hepatic
steatosis and severe hepatic steatosis were defined as controlled attenuation parameter
(CAP) ≥248 dB/m and ≥280 dB/m, respectively.
Results
A total of 330 patients (median age 50.5 years, 41.2% male, median HBV DNA 189 IU/ml)
were recruited. Twenty-two patients (6.7%) achieved HBsAg seroclearance during follow-up,
and the presence of hepatic steatosis was associated with a significantly higher chance
of HBsAg seroclearance (hazard ratio 3.246; 95% CI 1.278–8.243; p = 0.013). At baseline, 48.8% and 28.8% of patients had steatosis and severe steatosis,
respectively, while 4.2% had F3/F4 fibrosis at baseline, increasing to 8.7% at 3 years.
The rate of liver fibrosis progression in patients with persistent severe steatosis
was higher than in those without steatosis (41.3% vs. 23%; p = 0.05). Persistent severe hepatic steatosis was independently associated with fibrosis
progression (odds ratio 2.379; 95% CI 1.231–4.597; p = 0.01).
Conclusions
CAP measurements have predictive value in patients with virologically quiescent CHB.
The presence of hepatic steatosis was associated with a higher risk of fibrosis progression
but, paradoxically, a 3-fold increase in HBsAg seroclearance rate.
Lay summary
Co-existing fatty liver disease in patients with chronic viral hepatitis B infection
leads to worsening liver fibrosis, but also increases the chance of cure from hepatitis
B virus. Routine bedside assessment of liver fat content is important for risk assessment
in treatment-naïve patients with chronic hepatitis B.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: June 02, 2020
Accepted:
May 17,
2020
Received in revised form:
April 24,
2020
Received:
March 20,
2020
Identification
Copyright
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
