Steatotic liver disease in patients treated for chronic hepatitis B

Steatotic liver disease (SLD) can worsen the prognosis of other chronic liver diseases, including viral hepatitis.

The aim of the study was to assess patients with chronic hepatitis B virus (HBV) infection according to the presence or absence of SLD.

The study included consecutive white patients with chronic hepatitis B treated with nucleos(t)ide analogs (NAs), entecavir or tenofovir, for a median (interquartile range) of 6 (2-11) years, and evaluated between January 2023 and June 2024.

Of the 273 patients included in the analysis, 86 were diagnosed with SLD. Men constituted the majority of the overall population, with a higher percentage in the SLD group (77.9% vs 63.6%; P = 0.02). The burden of comorbidities was higher in the SLD group than in the non‑SLD group (P <0.001), including obesity (P <0.001), diabetes (P = 0.004), and gout (P = 0.03). Cirrhosis was diagnosed in 16.3% of the patients with SLD and 11.8% of those without SLD (P = 0.31). Aminotransferase activity was higher in the SLD group (P <0.001), while HBe antigen positivity was significantly less frequent in this population, and HBV DNA viral load was comparable between the groups. More than 97% of all patients achieved HBV DNA clearance during therapy, with a negative rate of 69.5% and 66.7% in the SLD and non‑SLD groups, respectively, after 1 year of treatment.

Liver steatosis was diagnosed in nearly one‑third of HBV‑infected patients treated with NAs. These patients were more likely to have obesity, diabetes, and gout, as compared with the non‑SLD population. Despite higher baseline aminotransferase activity in the SLD group, virological HBV activity and response to therapy were comparable between the patients with and without SLD.