To investigate the impact of fatty liver disease (FLD) on liver disease severity in a large North American cohort with chronic hepatitis B viral infection, liver biopsies from 420 hepatitis B surface antigen-positive adults that were enrolled in the Hepatitis B Research Network and who were not on HBV therapy in the previous month were evaluated for inflammation and fibrosis. Steatohepatitis was based on steatosis, hepatocyte ballooning, with or without Mallory-Denk bodies and perisinusoidal fibrosis. The models evaluated factors associated with steatohepatitis, and the association of steatohepatitis with fibrosis and longitudinal ALT, AST, and Fibrosis-4.
The median age was 42 years and 62.5% were male, 79.5% were Asian. A total of 132 (31.4%) patients had FLD (77 – 18.3%), steatosis only, 55 – 13.1% had steatohepatitis. Older age, overweight/obesity and diabetes were associated with steatohepatitis. Steatohepatitis versus no FLD was associated with 1.6% times higher risk of advanced fibrosis at baseline and there was indication of higher incident cirrhosis rate during followup. Steatohepatitis versus no FLD was also independently associated with 1.39 times higher ALT, 1.25 times higher Fibrosis-4. It was concluded that coexisting steatosis occurred in nearly one-third of adults of which 13% had steatohepatitis with chronic hepatitis B viral infection in this North American cohort who underwent liver biopsies. Steatohepatitis was associated with advanced fibrosis and higher biochemical measures of hepatic inflammation over time. There is indication for screening for and managing metabolic abnormalities in patients with HBV to prevent disease progression in HBV.
Khalili, M., Kleiner, D., King, W., et al. for the Hepatitis B Research Network (HBRN). “Hepatic Steatosis and Steatohepatitis in a Large North American Cohort of Adults with Chronic Hepatitis B.” American Journal of Gastroenterology; Vol. 116, August 2021, pp. 1686-1697.