Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia

Abstract

Hepatitis B virus (HBV) infection and nonalcoholic fatty liver disease (NAFLD) are two major causes of chronic liver disease (CLD) that can cause liver cirrhosis and hepatocellular carcinoma (HCC). 1,2 Although vaccination has dramatically reduced new HBV infection, WHO estimated 3.5% of the population worldwide (257 million people) were chronically infected with HBV in 2015. 3 Most Asian regions are medium to high prevalence areas of HBV infection. 4 Nowadays, NAFLD is the most common CLD in the world, with a global prevalence of about 25%. 2 Accompanied by the epidemic of obesity and change of lifestyle, the burden of NAFLD in Asia continues to increase and the prevalence is about 29%. 5 It is a trend to superimpose NAFLD on chronic HBV infection in Asia.Recently, the international fatty liver expert group proposed a new name as metabolic dysfunction-associated fatty liver disease (MAFLD), which partially overlaps with NAFLD. 6 This paper still uses the naming and definition of NAFLD because of most data coming from NAFLD related studies. We will review the epidemiology of concurrent NAFLD in chronic hepatitis B (CHB) patients and focus on the impact of concurrent NAFLD on the outcome of CHB patients in Asia.

Alanine aminotransferase to aspartate aminotransferase ratio and hepatitis B virus on metabolic syndrome: a community-based study

“…Nevertheless, patients with CHB with coexisting components of MetS are associated with more severe liver diseases. Li et al have reported that fatty liver was significantly associated with higher HBsAg seroclearance in patients with CHB (28), while concurrent NAFLD might inhibit HBV replication and promote HBsAg seroclearance (29). However, the fatty liver also exacerbates liver fibrosis.…”

Epidemiological characteristics and management of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis in China: A narrative review

“…For example, the prevalence of histologically diagnosed NAFLD in patients with CHB rose from 11.2% in 2005 to 32.5% in 2015 in mainland China, and was as high as 39.6% in Hong Kong. 42 Interestingly, patients with CHB appear to have a lower prevalence and incidence of NAFLD than the general population, and concurrent NAFLD may promote the clearance of hepatitis B surface antigen from serum and inhibit HBV replication. 43 However, there is such a synergistic effect of NAFLD and CHB on liver disease progression that severe steatosis and steatohepatitis can exacerbate liver fibrosis in patients with CHB.…”

“…43 However, there is such a synergistic effect of NAFLD and CHB on liver disease progression that severe steatosis and steatohepatitis can exacerbate liver fibrosis in patients with CHB. 42,43 The impact of NAFLD on HCC risk in patients with CHB is controversial, and the mechanism of interaction between HBV infection and NAFLD remains unclear. Nevertheless, patients with CHB should be closely monitored for coexisting NAFLD or NASH and receive lifelong metabolic management for a better prognosis.…”

“…With the increasing incidence of NAFLD over time, the number of people who have these two diseases concomitantly is growing. For example, the prevalence of histologically diagnosed NAFLD in patients with CHB rose from 11.2% in 2005 to 32.5% in 2015 in mainland China, and was as high as 39.6% in Hong Kong 42 . Interestingly, patients with CHB appear to have a lower prevalence and incidence of NAFLD than the general population, and concurrent NAFLD may promote the clearance of hepatitis B surface antigen from serum and inhibit HBV replication 43 .…”

The changing epidemiology of liver diseases in Asia

“…Finally, Yang et al reviewed the epidemiology of concurrent NAFLD in Asian CHB patients focusing on the impact on clinical outcomes 7 . CHB patients tend to have lower prevalence and incidence of NAFLD than the general population.…”