No influence of hepatic steatosis on the 3‐year outcomes of patients with quiescent chronic hepatitis B

Abstract

The influence of hepatic steatosis on the natural history of chronic hepatitis B (CHB) virus is unclear. Therefore, we investigated whether concurrent steatosis in patients with CHB influences the probability of hepatitis B surface antigen (HBsAg) loss, fibrosis progression and hepatocellular carcinoma (HCC) development. This study enrolled treatment‐naïve patients with virologically (HBV DNA <2,000 IU/ml) and biochemically (alanine aminotransferase level <40 IU/L) quiescent CHB who underwent transient elastography between January 2004 and December 2015 and completed 3 years of follow‐up. Results The mean age of the study population (n = 720) was 52.0 years, and there were more men than women (n = 419, 58.2%). The mean HBV DNA level was 321.6 IU/ml. During the 3‐year period, 74 (10.3%) patients achieved HBsAg seroclearance. Lower HBV DNA levels (hazard ratio = 0.995, p < .05) were independently associated with HBsAg seroclearance, while hepatic steatosis was not (p > .05). Fibrosis progressed in 89 (12.4%) patients. Male gender (odds ratio [OR] = 1.720) and higher body mass index (OR = 1.083) were independently associated with an increased probability of fibrosis progression (all p < .05), while higher total cholesterol levels (OR = 0.991) and higher liver stiffness values (OR = 0.862) were independently associated with a decreased probability of fibrosis progression (all p < .05). HCC developed in 46 (6.4%) patients. Male gender (OR = 3.917) and higher AST levels (OR = 1.036) were independently associated with an increased probability of HCC development (p < .05). Hepatic steatosis was not associated with the probability of HBsAg seroclearance, fibrosis progression or HCC development in patients quiescent CHB in our study. Further studies with longer follow‐up periods are required to validate our findings.

Hepatitis B virus infection combined with nonalcoholic fatty liver disease: Interaction and prognosis

“…Conversely, there are studies that do not consider NAFLD to have an effect on spontaneous HBsAg clearance. A Korean study (HBV DNA-negative CHB patients, n = 720) with 3-year follow up found no correlation between HS and spontaneous HBsAg clearance (P = 0.518) [ 32 ].…”

“…Nevertheless, several studies showed no correlation between steatosis and fibrosis [ 66 , 67 ]. For instance, in a retrospective study in South Korea, treatment-naïve CHB patients with normal ALT and HBV DNA <2000IU/ml were followed up for 3 years and no correlation was found between HS and fibrosis progression (OR = 1.09, 95%CI 0.64–1.85) [ 32 ].…”

“…Still other studies did not find HS associated with the development of HCC in CHB patients. In a retrospective Korean study of 720 treatment-naïve CHB patients with normal ALT and HBV DNA <2000 IU/ml followed for 3 years, HS was not associated with the development of HCC (OR = 1.04,95%CI 0.57–1.89) [ 32 ]. Two other Korean studies, in CHB patients receiving NA, likewise did not find a correlation between HS and HCC development [ 39 , 72 ].…”

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

“…While there exists growing evidence that NAFLD may provide some benefit in reducing disease progression in CHB patients, there are some studies that have suggested otherwise. Jin et al [ 25 ] retrospectively analyzed 720 CHB patients in 3 years and found that HS was not significantly associated with HBsAg seroclearance, fibrosis progression, or HCC development. However, their study may be influenced by its retrospective nature with a relatively short follow-up duration.…”

“…[ 70 , 71 ] In addition, several other studies have suggested that HS is not a risk factor for the probability of fibrosis progression or HCC development in CHB patients. [ 13 , 25 , 71 – 73 ]…”