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Diverse effects of hepatic steatosis on fibrosis progression and functional cure in virologically quiescent chronic hepatitis B
- Source :
- Journal of hepatology. 73(4)
- Publication Year :
- 2020
-
Abstract
- 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.Treatment-naïve patients with CHB, normal alanine aminotransferase and low viraemia (serum HBV DNA2,000 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.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).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.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.
- Subjects :
- 0301 basic medicine
Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Hepatitis B virus
Disease
medicine.disease_cause
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Hepatitis B, Chronic
Fibrosis
Non-alcoholic Fatty Liver Disease
Risk Factors
Internal medicine
medicine
Humans
Retrospective Studies
Hepatitis B Surface Antigens
Hepatology
business.industry
Fatty liver
Hazard ratio
Odds ratio
Middle Aged
medicine.disease
030104 developmental biology
Liver
Concomitant
DNA, Viral
Hong Kong
030211 gastroenterology & hepatology
Female
Steatosis
Morbidity
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 16000641
- Volume :
- 73
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of hepatology
- Accession number :
- edsair.doi.dedup.....61417ac45de96bbf0330fc5613da8317