Impact of HBV infection on clinical outcomes in patients with metabolic dysfunction-associated fatty liver disease

Yu-Ming Cheng; Tsung-Han Hsieh; Chia-Chi Wang; Jia-Horng Kao

doi:10.1016/j.jhepr.2023.100836

Impact of HBV infection on clinical outcomes in patients with metabolic dysfunction-associated fatty liver disease

JHEP Rep. 2023 Jun 29;5(9):100836. doi: 10.1016/j.jhepr.2023.100836. eCollection 2023 Sep.

Authors

Yu-Ming Cheng¹, Tsung-Han Hsieh², Chia-Chi Wang³, Jia-Horng Kao^{4

5}

Affiliations

¹ Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan.
² Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
³ Department of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Hualien, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

Abstract

Background & aims: The new name and diagnostic criteria of metabolic-associated fatty liver disease (MAFLD) was proposed in 2020. Although chronic HBV infection has protective effects on lipid profiles and hepatic steatosis, the impact of chronic HBV infection on clinical outcomes of MAFLD requires further investigation.

Methods: The participants from a Taiwan bio-bank cohort were included. MAFLD is defined as the presence of hepatic steatosis plus any of the following three conditions: overweight/obesity, type 2 diabetes mellitus, and metabolic dysfunction. The patients with positive glycated haemoglobin were considered as having chronic HBV infection. Atherosclerosis was determined as having carotid plaques on duplex ultrasound. Advanced liver fibrosis was defined as Fibrosis-4 >2.67. Based on the status of MAFLD and HBV infection, the participants were distributed into four groups: 'dual aetiology', 'MAFLD alone', 'HBV alone', and 'healthy controls'.

Results: A total of 20,460 participants (age 55.51 ± 10.37; males 32.67%) were included for final analysis. The prevalence of MAFLD and chronic HBV infections were 38.8% and 10.3%, respectively. According to univariate analysis, 'HBV alone' group had lower levels of glycated haemoglobin, lipid profiles, and intima media thickness than healthy controls. The 'dual aetiology' group had lower levels of triglycerides, cholesterol, γ-glutamyl transferase, intima media thickness, and percentage of carotid plaques than 'MAFLD alone' group. Using binary logistic regression, chronic HBV infection increased the overall risk of advanced liver fibrosis; and had a lower probability of carotid plaques in MAFLD patients, but not in those without MAFLD.

Conclusions: The large population-based study revealed chronic HBV infection increases the overall risk of liver fibrosis, but protects from atherosclerosis in patients with MAFLD.

Impact and implications: Patients with metabolic-associated fatty liver disease can also be coinfected with chronic HBV. Concomitant HBV infection increases the overall risk of liver fibrosis, but protects from atherosclerosis in patients with MAFLD.

Keywords: Atherosclerosis; Carotid plaque; Fatty liver index; Fibrosis-4 score; Hepatic B virus; Hepatic steatosis; Intima media thickness; Liver fibrosis; Metabolic associated fatty liver disease; NAFLD fibrosis score; Non-alcoholic liver disease.