Diagnosis and management of metabolic dysfunction-associated steatohepatitis in patients with chronic hepatitis B infection

Core Tip

Core Tip: In context of a growing global burden of obesity and diabetes mellitus, metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic syndrome are increasingly observed in patients with chronic hepatitis B (CHB) virus infection. The relationship between hepatic steatosis and/or metabolic syndrome with CHB is complex and remains incompletely defined, although multiple cohort studies reveal an association with liver inflammation, liver fibrosis, hepatitis B virus (HBV)-related liver events such as cirrhosis, liver failure, and liver cancer, as well as biochemical and virologic response to antiviral therapy. Therefore, a dual diagnosis of MASLD and CHB, also termed met-HBV, may have important implications for management. Probable met-HBV can initially be identified on the basis of liver imaging, but a confirmed diagnosis can be established on vibration-controlled transient elastography-based controlled attenuation parameter score or liver biopsy. Patients diagnosed with met-HBV should undergo active management of MASLD and other manifestations of the metabolic syndrome. Future cohort studies and controlled trials are needed to inform evidence-based approaches to management.