High incidence of hepatitis B core antibody positivity in metabolic-associated fatty liver disease-related cirrhosis

Abstract

Background and Aim:The coexistence of metabolic-associated fatty liver disease (MAFLD) in the course of chronic hepatitis B virus infection increases liver-related morbidity. A positive correlation was found between positive hepatitis B core antibody (anti-HBc) and the risk of cirrhosis and hepatocellular carcinoma (HCC) in MAFLD. The relationship between anti-HBc positivity and MAFLD progression to fibrosis, cirrhosis, and liver-related outcomes was determined. Materials and Methods:This is a retrospective study including 242 patients with biopsy-proven MAFLD, 130 patients with clinically diagnosed MA-FLD-related cirrhosis, and 62 patients with MAFLD-related or cryptogenic HCC. Anti-HBc antibody results were compared with clinical outcomes.Results: Anti-HBc positivity was associated with fibrosis severity (p=0.005). Anti-HBc was positive in 19 (20.2%), 33 (25.8%), 53 (35.3%), and 27 (43.5%) patients with F0-F1 fibrosis, F2-F3 fibrosis, cirrhosis (F4), and HCC, respectively. Median steatosis score was grade 3 in anti-HBc positive patients and grade 2 in negative patients (p=0.07). Anti-HBc positivity was not associated with significant fibrosis (≥F2), cirrhosis, and any liver related complications including HCC. Conclusion:Higher anti-HBc positivity was found in MAFLD patients with advanced fibrosis and cirrhosis compared to patients with early stage fibrosis. No relation was found between anti-HBc positivity and development of cirrhosis, HCC or other liver related complications.

Redefining non-alcoholic fatty liver disease to metabolic associated fatty liver disease: Is this plausible?

“…The MAFLD criteria were found more accurate than older NAFLD criteria when analyzing momentous hepatic fibrosis in the patients with cardiovascular disease[ 31 , 32 ], chronic kidney disease[ 33 ], and appraisal of genetic risk factors[ 34 ] in fatty liver disease. It also implies that MAFLD may coexist with other liver diseases, for instance, hepatitis B and C[ 15 , 35 - 37 ], HIV infection[ 38 ], Gaucher[ 39 ], and coeliac disease[ 40 ], hence making it more plausible than NAFLD. Table 1 shows all the studies comparing the two terms[ 41 - 44 ].…”

MAFLD: A quick fact check

“…In fact, there is clear evidence pointing to worse liver histology regarding fibrosis development in patients with MAFLD plus another important factor, such as higher anti-HBc positivity, or mild alcohol consumption. 14,28 Continuous new research shows easier identification of patients with fatty liver who have high risk of progression, as well as better identification of the difference in risk factors among MAFLD and…”

“…Furthermore, the diagnosis of MAFLD does not exclude the possibility of concurrent etiologies for the fatty liver disease spectrum, such as alcohol use or viral hepatitis. In fact, there is clear evidence pointing to worse liver histology regarding fibrosis development in patients with MAFLD plus another important factor, such as higher anti‐HBc positivity, or mild alcohol consumption 14,28 . Continuous new research shows easier identification of patients with fatty liver who have high risk of progression, as well as better identification of the difference in risk factors among MAFLD and NAFLD, emphasizing the adequate metabolic disease management that we must take about 29,30 …”

MAFLD: A game changer redefining fatty liver disease for adults and children

“…The definition identifies patients with significant hepatic fibrosis, 6,7 cardiovascular disease, 8,9 chronic kidney disease, 7,10 and those who would benefit from an evaluation of genetic risks for fatty liver 11 better than the previous NAFLD criteria. Its utility has also been demonstrated in patients with other diseases such as hepatitis B, 12,13 hepatitis C, 14,15 HIV, 16 coeliac disease 17 and Gaucher disease, 18 in all of which NAFLD cannot be concomitantly diagnosed. Hegarty et al, express their enthusiastic support for the MAFLD definition and indicate that the rationale behind the redefinition of fatty liver disease in adults is equally applicable for children.…”