Hepatic steatosis was independently associated with a lower risk for cirrhosis and hepatocellular carcinoma (HCC) and had a greater chance of achieving hepatitis B surface antigen (HBsAg) seroclearance among Asian patients with chronic hepatitis B (CHB) treated with antiviral therapy, according to study results published in The Journal of Infectious Diseases.
This retrospective study investigated the cumulative 10-year incidence of cirrhosis, HCC, and HBsAg seroclearance in CHB patients with and without hepatic steatosis from 5 US and 2 Taiwanese centers. The 3 outcomes were compared in the overall CHB cohort stratified by antiviral treatment status and a propensity score-matched cohort based on the following characteristics: age, sex, BMI, history of alcohol use, diabetes, baseline cirrhosis, antiviral treatment status, study region, follow-up time, and levels of HBV DNA, hepatitis B e-antigen (HBeAg), alanine aminotransferase, and aspartate aminotransferase. Patients were monitored every 3 to 6 months with routine blood tests and liver ultrasound or computerized tomography.
Of the 6786 patients with CHB (mean age, 46.24±11.63 years) included in the study, 63.47% were men, 21.91% were HBeAg positive, and 37.61% received antiviral therapy. There were 2141 patients with CHB and concurrent hepatic steatosis with a mean BMI of 25.453.69 kg/m2. The propensity score-matched cohort included 1079 patients in each group (those with hepatic steatosis and those without hepatic steatosis).
In the overall CHB cohort, patients with hepatic steatosis had a lower incidence for cirrhosis (9.10% vs 12.07%; P <.0001) and HCC (3.74% vs 6.18%; P =.0001), and a higher rate of HBsAg seroclearance (13.42% vs 9.97%; P =.004) compared with patients without hepatic steatosis. When stratified by those who received antiviral treatment, the incidence rate for cirrhosis and HCC remained similar, but there was no difference in the rate of HBsAg seroclearance.
In the propensity score-matched cohort, patients with hepatic steatosis again had a lower incidence for cirrhosis (10.52% vs 15.47%; P =.0001) and HCC (4.51% vs 6.48%; P =.06), and a higher rate of HBsAg seroclearance (16.19% vs 5.92%; P =.05) compared with patients without hepatic steatosis.
When stratified by those who received antiviral treatment, hepatic steatosis was significantly and independently associated with a lower risk for cirrhosis (adjusted hazard ratio [aHR], 0.19; 95% CI, 0.12-0.33; P <.001) and HCC (aHR, 0.21; 95% CI, 0.09-0.51; P =.001). However, the rate of HBsAg seroclearance was not statistically significant (aHR, 2.19; 95% CI, 0.75-6.40; P =.15) with its smaller sample size.
In a sensitivity analysis that included only patients with no history of alcohol use, hepatic steatosis not only remained associated with a lower risk for cirrhosis (aHR, 0.14; 95% CI, 0.07-0.28; P <.001) and HCC (aHR, 0.05; 95% CI, 0.01-0.35; P =.003) but also showed a higher chance of HBsAg seroclearance (aHR, 5.23; 95% CI, 1.15-23.91; P =.03).
Because all patients in this study were Asian, further studies are needed to “confirm our findings and to investigate this association for other race/ethnicities as well as to characterize the precise mechanisms for these observations,” the authors concluded.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Li J, Yang HI, Yeh ML, et al. Association between fatty liver and cirrhosis, hepatocellular carcinoma, and HBsAg seroclearance in chronic hepatitis B. Published online November 29, 2020. J Infect Dis. doi:10.1093/infdis/jiaa739