Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion

Abstract

With the increasing incidence of obesity and metabolic syndrome worldwide, concomitant nonalcoholic fatty liver disease (NAFLD) in patients with chronic hepatitis B (CHB) has become highly prevalent. The risk of dual etiologies, outcome, and mechanism of CHB with concomitant NAFLD have not been fully characterized. In this review, we assessed the overlapping prevalence of metabolic disorders and CHB, assessed the risk of advanced fibrosis/hepatocellular carcinoma in CHB patients concomitant with NAFLD, and discussed the remaining clinical issues to be addressed in the outcome of such patients. We also explored the possible roles of hepatitis B virus in the development of steatosis and discussed difficultiesof histological evaluation. For CHB patients, it is important to address concomitant NAFLD through lifestyle management and disease screening to achieve better prognoses. The assessment of progressive changes and novel therapies for CHB patients concomitant with NAFLD deserve further research.

Keywords: Nonalcoholic fatty liver disease; Hepatitis B; Metabolic disorders; Steatosis; Mechanism; Disease burden

Core Tip: The pathophysiology of concomitant hepatitis B and hepatic steatosis remains unclear. This review comprehensively discusses the epidemiology, risk factors, long-term outcomes, histological assessment, potential mechanisms, and therapeutic options in this field. We believe further studies can clarify the interactions of hepatitis B virus and steatosis, and provide novel strategies for the management of hepatitis B patients with concomitant steatosis.