Influence of nonalcoholic fatty liver disease on the therapeutic effect of nucleoside (acid) analogs for hepatitis B virus

doi:10.4254/wjh.v16.i12.1395

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Dec 27, 2024; 16(12): 1395-1406
Published online Dec 27, 2024. doi: 10.4254/wjh.v16.i12.1395

Influence of nonalcoholic fatty liver disease on the therapeutic effect of nucleoside (acid) analogs for hepatitis B virus

Hua-Dong Li, Ya-Nan Liu, Shuang Wu, Xu-Feng Quan, Xiao-Yan Wang, Tian-Dan Xiang, Shu-Meng Li, Ling Xu, Tong Wang, Hua Wang, Xin Zheng

Hua-Dong Li, Ya-Nan Liu, Xu-Feng Quan, Xiao-Yan Wang, Tian-Dan Xiang, Shu-Meng Li, Ling Xu, Tong Wang, Hua Wang, Xin Zheng, Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China

Hua-Dong Li, Shuang Wu, Department of Infectious Diseases, Wuhan Jinyintan Hospital, Wuhan 430023, Hubei Province, China

Co-first authors: Hua-Dong Li and Ya-Nan Liu.

Co-corresponding authors: Hua Wang and Xin Zheng.

Author contributions: Li HD was responsible for the data curation, investigation, methodology, writing-original draft, writing-review and editing; Liu YN participated in the data curation, investigation, and editing; Wang H participated in the data curation and methodology; Wu S, Quan XF, Wang XY, Xiang TD, Li SM, Xu L, and Wang T participated in data curation and editing; Zheng X was responsible for methodology, supervision, acquired funding, writing–review and editing.

Supported by National Science and Technology Major Project of China, No. 92169121; National Key R and D Projects, No. 2022YFC2305100; and Wuhan Science and Technology Bureau Knowledge Innovation Special Foundation of Hubei Province, No. 2022020801010588.

Institutional review board statement: This study was performed in accordance with the guidelines of the Helsinki Declaration and had been approved by the Ethics Committee of Wuhan Jinyintan Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology (Approval No. KY-2023-12).

Informed consent statement: As this is a retrospective cohort study and the data is anonymous, the requirement for informed consent has been waived.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: Data are available from the corresponding author upon reasonable request.

STROBE statement: The authors have read the STROBE Statement -checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Corresponding author: Xin Zheng, MD, PhD, Professor, Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. xinz@hust.edu.cn

Received: August 18, 2024
Revised: October 2, 2024
Accepted: October 29, 2024
Published online: December 27, 2024
Processing time: 103 Days and 0.8 Hours

Abstract

BACKGROUND

The effect of nonalcoholic fatty liver disease (NAFLD) on the efficacy of nucleoside analogues (NAs) in antiviral therapy for patients with chronic hepatitis B (CHB) remains controversial.

AIM

To investigate the influence of NAFLD on virological response in CHB patients undergoing NAs treatment.

METHODS

Logistic regression analysis was conducted on a cohort of 465 CHB patients from two hospitals to determine whether NAFLD was a risk factor for adverse reactions to NAs. CHB patients were followed up for more than 28 months after initial antiviral treatment, and further validation was performed using different viral load populations.

RESULTS

NAFLD was identified as an independent risk factor for partial virological response following antiviral therapy with NAs (odds ratio = 1.777, P = 0.017). In our subsequent analysis focusing on CHB patients with high viral load, the NAFLD group exhibited significantly longer virus shedding time and lower proportion of the complete virological response compared with the non-NAFLD group (16.8 ± 6.1 vs 13.0 ± 6.8, P < 0.05). During the 24-month period of antiviral treatment with NAs, hepatitis B virus (HBV) DNA levels decreased slowly in the NAFLD group, and the negative conversion rate of HBV was notably lower than that observed in non-NAFLD group (P = 0.001). Similar results were obtained when analyzing patients with low baseline HBV viral load within the NAFLD group.

CONCLUSION

Coexistence of NAFLD may diminish virological response among CHB patients receiving antiviral treatment with NAs.

Keywords: Nonalcoholic fatty liver disease; Chronic hepatitis B; Nucleoside analogues; Antiviral therapy; Virological response

Core Tip: The effect of nonalcoholic fatty liver disease (NAFLD) on the antiviral therapy with nucleoside analogues (NAs) in patients with chronic hepatitis B (CHB) is controversial. The aim of this study was to investigate the virological response to first-line NAs antiviral treatment in patients with NAFLD and CHB, through dynamically monitoring virology indicators for 96 weeks, to determine the influence of NAFLD on the efficacy of NAs anti- hepatitis B virus treatment. To our knowledge, this is the first grading study based on HBV baseline viral load that confirms a reduction in virological response to NAs antiviral treatment caused by NAFLD.