Chronic Viral Hepatitis B and C Outweigh MASLD in the Associated Risk of Cirrhosis and HCC
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Published on: September 30, 2021
Mei-Hsuan Lee1, Yi-Ting Chen2, Yu-Han Huang2
1Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Advanced Therapeutics Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Master of Public Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) significantly increases cirrhosis and liver cancer risks, especially with chronic hepatitis B or C. Prioritizing viral hepatitis treatment is crucial.
Area of Science:
- Hepatology
- Gastroenterology
- Public Health
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence is rising globally.
- The interplay between MASLD, chronic viral hepatitis (CHB/C), and liver disease progression (cirrhosis, HCC) remains incompletely understood.
- Antiviral treatment's role in modifying these risks requires further investigation.
Purpose of the Study:
- To investigate the impact of MASLD on the development of cirrhosis and hepatocellular carcinoma (HCC) in individuals with and without chronic hepatitis B or C (CHB/C).
- To assess the influence of antiviral treatment status on these outcomes.
- To quantify the combined risks associated with MASLD and CHB/C infection.
Main Methods:
- A prospective cohort study of 336,866 adults (≥30 years) screened between 1997-2013.
- MASLD diagnosis via abdominal ultrasonography and cardiometabolic profiles.
- Data linkage with national health, cancer, and death registries for follow-up until December 2019.
Main Results:
- MASLD was present in 36.4% of the cohort; 5562 cirrhosis and 2273 HCC cases were diagnosed over 15 years.
- MASLD significantly increased cirrhosis/HCC risk (P < .0001).
- The highest HCC risk was observed in patients with both MASLD and CHB/C (HRadj=8.86), followed by CHB/C alone (HRadj=8.81) and MASLD alone (HRadj=1.52), compared to controls.
Conclusions:
- MASLD significantly elevates the risk of cirrhosis and HCC, particularly when co-existing with chronic viral hepatitis.
- Even with antiviral treatment for CHB/C, MASLD remains associated with increased risks of cirrhosis and HCC.
- These findings highlight the critical need to prioritize the management of chronic viral hepatitis before focusing on MASLD in at-risk populations.
Background & Aims:
The impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on the development of cirrhosis and hepatocellular carcinoma (HCC) by chronic hepatitis B (CHB) or C infection and antiviral treatment statuses is not well-known.
Methods:
A total of 336,866 adults aged ≥30 years were prospectively enrolled in a health screening program between 1997-2013. MASLD was identified by abdominal ultrasonography and cardiometabolic profiles. Data linkage was performed using 3 nationwide databases-National Health Insurance, Cancer Registry, and Death Certification System-to obtain information on antiviral treatment, vital status, and newly diagnosed cirrhosis and HCC. Follow-up was conducted until December 31, 2019.
Results:
In the total population, 122,669 (36.4%) had MASLD. Over a mean follow-up of 15 years, 5562 new cases of cirrhosis and 2273 new cases of HCC were diagnosed. Although MASLD significantly increased the cumulative risks of cirrhosis or HCC (P < .0001), the associated risk was more pronounced when comparing CHB or C infection with the presence of MASLD. Stratifying the participants based on their MASLD and CHB or C statuses, hazard ratios (HRadj) with 95% confidence intervals for HCC were 8.81 (7.83-9.92) for non-steatotic liver disease (SLD) with CHB or C, 1.52 (1.32-1.74) for MASLD without CHB or C, and 8.86 (7.76-10.12) for MASLD with CHB or C, compared with non-SLD without CHB or C (all P < .0001). Among CHB or C patients who received antivirals during follow-up, MASLD was associated with increased risks of cirrhosis and HCC, with HRadj of 1.23 (1.01-1.49) and 1.32 (1.05-1.65), respectively.
Conclusions:
These findings underscore the need to prioritize treatment of chronic viral hepatitis before addressing MASLD.
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