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

Table 1 Risk of disease progression in chronic hepatitis B patients with metabolic dysfunction-associated steatotic liver disease

Study population	SLD diagnosis	Viral suppression	Disease progression	Outcomes
1202 CHB patients with or without steatosis[57]	VCTE	Lower median serum HBV DNA levels	Severe steatosis associated with increase severe fibrosis in treatment-naïve and treated patients	Fibrosis progression (increase)
330 treatment-naive patients with CHB[58]	VCTE	HBsAg seroclearance	Persistent severe hepatic steatosis independently associated with fibrosis progression (OR = 2.379)	Fibrosis progression (increase)
606 patients with CHB[62]	VCTE	HBsAg seroclearance	Severe steatosis associated with severe fibrosis in treatment-naive (OR = 3.60) and treated (OR: 1.95-2.79) patients	Fibrosis severity (increase)
Meta-analysis: 34 studies with 68268 CHB patients[63]	VCTE/biopsy-proven steatosis	HBsAg seroclearance (OR = 2.22)	Steatosis associated with cirrhosis (OR = 1.52) and HCC (OR = 1.59)	Cirrhosis (increase), HCC (increase)
1089 patients with CHB[59]	Biopsy data	HBsAg seroclearance	Steatohepatitis + CHB more advanced fibrosis and shorter time to liver-related outcomes/death	Fibrosis (increase), outcomes worse
197346 patients with CHB (South Korea NHIS)[64]	MASLD criteria	HBsAg seroclearance	Risk of HCC was 1.4-fold higher in CHB + MASLD	HCC (increase)
11502 patients with CHB[65]	MASLD criteria	Lower HBV DNA levels	MASLD patients had higher risk of cirrhosis	Cirrhosis (increase)
10546 treatment-naive CHB patients[66]	MASLD criteria	Fewer HBeAg positivity, lower HBV DNA levels	Steatosis + metabolic dysfunction increase risk of HCC (aHR 1.40 per dysfunction)	HCC (increase)

CHB: Chronic hepatitis B; NHIS: National Health Interview Survey; VCTE: Vibration-controlled transient elastography; MASLD: Metabolic dysfunction-associated steatotic liver disease; SLD: Steatotic liver disease; HBeAg: Hepatitis B e antigen; HBV: Hepatitis B virus; OR: Odds ratio; HCC: Hepatocellular carcinoma; aHR: Adjusted hazard ratio.