Essential reading from the editor’s desk

Abstract

The prevalence of metabolic dysfunction associated liver disease (MALFD) – previously known as non- alcoholic fatty liver disease (NAFLD) – has increased dramatically in the past few decades and is now the most common cause of chronic liver disease worldwide (1-4). Nevertheless, chronic hepatitis B (HBV) remains an important cause of cirrhosis and hepatocellular carcinoma on a global scale (5). Even if there is still controversy which patients to treat with antiviral therapy (e.g. high DNA levels with normal aminotransferase levels), it is clear that treatment reduces disease progression and improves survival in the presence of active necroinflammation (5,6). In the current edition of the Acta Gastro-Enterologica Belgica, Gok Sargin and colleagues have performed a large retrospective cohort study in 469 patients with chronic hepatitis B to evaluate adverse effects of the three approved antivirals: entecavir, tenofovir disoproxil fumarate and tenofovir alafenamide (7). Efficacy in terms of DNA suppression, normalization of aminotransferase levels and HBsAg seroconversion was comparable in the three groups. All treatments were associated with a mild decrease in renal function, but without a difference between the groups. Finally, no differences were observed in terms of metabolic complications including bone mineral density and lipid profiles.