MASLD and viral hepatitis overlap: An emerging dual burden in chronic liver disease

The coexistence of metabolic dysfunction-associated steatotic liver disease (MASLD) and viral hepatitis has gained greater focus due to the global increase in chronic liver diseases. This convergence of conditions creates a unique clinical entity characterized by complex molecular interactions, difficult diagnosis, and treatment issues. The frequency of MASLD alongside viral hepatitis is becoming more prevalent. Overlapping pathogenic mechanisms, such as insulin resistance, activation of pro-inflammatory cytokines, hepatic steatosis, and persistent viral infection, establish a synergistic pathophysiological relationship that exacerbates fibrosis and liver damage. Non-invasive fibrosis assessments, multimodal imaging, and, in certain cases, liver biopsies are often required to achieve diagnostic accuracy. This review intends to examine the epidemiological overlap, shared pathophysiological mechanisms, diagnostic hurdles, and management challenges associated with the concurrent manifestation of MASLD and viral hepatitis.