Clinical impact and mechanisms of hepatitis B virus infection concurrent with non-alcoholic fatty liver disease

Tong, Xin; Song, Yu; Yin, Shengxia; Wang, Jian; Huang, Rui; Wu, Chao; Shi, Junping; Li, Jie

doi:10.1097/cm9.0000000000002310

Cited by 8 publications

(10 citation statements)

References 118 publications

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“…The study [ 11 ] demonstrated that NAFLD inhibits HBV without affecting host lipid homeostasis. However, the study [ 12 ] reported that antiviral therapy was ineffective in CHB patients with high CAP (controlled attenuation parameter). Therefore, there is controversy about how NAFLD affects CHB.…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of How Nonalcoholic Fatty Liver Disease Affect Antiviral Treatment of Patients with e Antigen-Positive Chronic Hepatitis B

Chen

Liu

Han

et al. 2022

Emergency Medicine International

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Background. Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are both the most common underlying diseases leading to cirrhosis and hepatocellular carcinoma, and NAFLD and HBV infection are the first and second leading causes of chronic liver disease in China. However, there are still a lot of controversies about whether the combined presence of CHB and NAFLD will affect the course or outcome of liver disease together with HBV, and how the two affect each other. Objective. To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on antiviral therapy in patients with chronic hepatitis B (CHB). Methods. Computer searches of databases such as PubMed, CNKI, VIP.com, and Wanfang Data Knowledge Service Platform were used. The time frame was from the creation of the database to June 2022. The search subject terms were hepatitis B, CHB, or NAFLD. The observation group consisted of patients with e antigen-positive CHB with NAFLD, and the control group consisted of patients with e-antigen + CHB. Extracts including title, name, date of publication, number of samples, antiviral drugs, and outcome indicators were used for Meta-analysis. Funnel plots were drawn to analyze literature bias. Results. Seven papers including 1348 patients with HBeAg + CHB (observation group: n = 547, control group: n = 801) were finally included. Results. Meta-analysis showed that CHB patients with NAFLD had lower efficacy than CHB patients after 48 weeks of antiviral treatment with nucleotide analogs, as measured by three outcome indicators HBV DNA conversion rate, ALT-normalization, and HBeAg conversion rate. Conclusion. NAFLD reduces the effect of antiviral therapy in CHB patients, and the clinicopathological features of patients with NAFLD combined with chronic hepatitis B are different from those of patients with chronic hepatitis B alone, so early diagnosis by liver histological examination should be actively performed and reasonable antiviral therapy should be administered.

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Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of How Nonalcoholic Fatty Liver Disease Affect Antiviral Treatment of Patients with e Antigen-Positive Chronic Hepatitis B

Chen

Liu

Han

et al. 2022

Emergency Medicine International

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“…The results indicated that when patients were treated with IFNs or NAs, those with CHB and hepatic steatosis did not exhibit any significant difference from those with only CHB. The outcome of treatment with oral antivirals or interferons appears to be unaffected by HS[ 19 ]. Some studies have reported that fat accumulation in hepatocytes may minimize the contact area between drugs and hepatocytes, which can result in a low antiviral response to Nas[ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the degree of hepatic steatosis was unclear in most studies, with no reference to NASH. The coexistence of NAFLD may independently increase the risk of HCC development, which is likely to be the same mechanism through which NAFLD alone induces HCC[ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of nonalcoholic fatty liver disease on response to antiviral treatment in patients with chronic hepatitis B: A meta-analysis

Liu,

Wang,

Liu

et al. 2024

World J Hepatol

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BACKGROUND Although hepatitis B virus infection is the leading cause of chronic liver injury globally, nonalcoholic fatty liver disease (NAFLD) is gradually gaining attention as another major chronic liver disease. The number of patients having chronic hepatitis B (CHB) with concomitant hepatic steatosis has increased. AIM To analyze the effect of NAFLD on the response to antiviral treatment in patients with CHB. METHODS Relevant English studies were systematically searched across PubMed, EMBASE, Web of Science, and Cochrane Library until October 2023. Studies in which the treatment outcomes were compared between patients with CHB only and those with CHB and hepatic steatosis were included. RESULTS Of the 2502 retrieved studies, 11 articles were finally included. Biochemical response until 48 wk (OR = 0.87, 95%CI: 0.50–1.53, P = 0.000) and 96 wk (OR = 0.35, 95%CI: 0.24–0.53, P = 0.24) and virological response until 96 wk (OR = 0.80, 95%CI: 0.43–1.49, P = 0.097) were lower in patients with hepatic steatosis than in patients with CHB alone. CONCLUSION Hepatic steatosis lowers the biochemical response to antiviral treatment in patients with CHB.

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“…have proposed two opposite effects of HBV infection on steatosis. Specifically, CHB could be correlated with decreased risk of hyperlipidemia and lower prevalence of steatosis, probably due to an elevated serum adiponectin level and increased hepatic lipid accumulation could be induced by HBx overexpression and the observed genetic susceptibility to fatty liver in CHB patients ( 220 ). We must also consider the significance of the immune homeostasis imbalance which characterizes both HBV infection and NAFLD and its implication in liver disease progression to HCC.…”

Section: Discussionmentioning

confidence: 99%

NAFLD and HBV interplay - related mechanisms underlying liver disease progression

Tourkochristou

Assimakopoulos²,

Thomopoulos³

et al. 2022

Front. Immunol.

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Non-alcoholic fatty liver disease (NAFLD) and Hepatitis B virus infection (HBV) constitute common chronic liver diseases with worldwide distribution. NAFLD burden is expected to grow in the coming decade, especially in western countries, considering the increased incidence of diabetes and obesity. Despite the organized HBV vaccinations and use of anti-viral therapies globally, HBV infection remains endemic and challenging public health issue. As both NAFLD and HBV have been associated with the development of progressive fibrosis, cirrhosis and hepatocellular carcinoma (HCC), the co-occurrence of both diseases has gained great research and clinical interest. The causative relationship between NAFLD and HBV infection has not been elucidated so far. Dysregulated fatty acid metabolism and lipotoxicity in NAFLD disease seems to initiate activation of signaling pathways that enhance pro-inflammatory responses and disrupt hepatocyte cell homeostasis, promoting progression of NAFLD disease to NASH, fibrosis and HCC and can affect HBV replication and immune encountering of HBV virus, which may further have impact on liver disease progression. Chronic HBV infection is suggested to have an influence on metabolic changes, which could lead to NAFLD development and the HBV-induced inflammatory responses and molecular pathways may constitute an aggravating factor in hepatic steatosis development. The observed altered immune homeostasis in both HBV infection and NAFLD could be associated with progression to HCC development. Elucidation of the possible mechanisms beyond HBV chronic infection and NAFLD diseases, which could lead to advanced liver disease or increase the risk for severe complications, in the case of HBV-NAFLD co-existence is of high clinical significance in the context of designing effective therapeutic targets.

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Clinical impact and mechanisms of hepatitis B virus infection concurrent with non-alcoholic fatty liver disease

Cited by 8 publications

References 118 publications

A Meta-Analysis of How Nonalcoholic Fatty Liver Disease Affect Antiviral Treatment of Patients with e Antigen-Positive Chronic Hepatitis B

A Meta-Analysis of How Nonalcoholic Fatty Liver Disease Affect Antiviral Treatment of Patients with e Antigen-Positive Chronic Hepatitis B

Influence of nonalcoholic fatty liver disease on response to antiviral treatment in patients with chronic hepatitis B: A meta-analysis

NAFLD and HBV interplay - related mechanisms underlying liver disease progression

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