Metabolic Dysfunction-Associated Steatotic Liver Disease Facilitates Hepatitis B Surface Antigen Seroclearance and Seroconversion

Shang-Chin Huang; Tung-Hung Su; Tai-Chung Tseng; Chi-Ling Chen; Shih-Jer Hsu; Chen-Hua Liu; Sih-Han Liao; Chun-Ming Hong; Ting-Yuan Lan; Hung-Chih Yang; Chun-Jen Liu; Pei-Jer Chen; Jia-Horng Kao

doi:10.1016/j.cgh.2023.09.040

Metabolic Dysfunction-Associated Steatotic Liver Disease Facilitates Hepatitis B Surface Antigen Seroclearance and Seroconversion

Clin Gastroenterol Hepatol. 2024 Mar;22(3):581-590.e6. doi: 10.1016/j.cgh.2023.09.040. Epub 2023 Oct 21.

Authors

Shang-Chin Huang¹, Tung-Hung Su², Tai-Chung Tseng³, Chi-Ling Chen⁴, Shih-Jer Hsu⁵, Chen-Hua Liu⁵, Sih-Han Liao⁶, Chun-Ming Hong⁷, Ting-Yuan Lan⁸, Hung-Chih Yang⁵, Chun-Jen Liu⁹, Pei-Jer Chen¹⁰, Jia-Horng Kao¹¹

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: tunghungsu@ntu.edu.tw.
³ Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
⁶ National Taiwan University Cancer Center, Taipei, Taiwan.
⁷ Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
⁹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: kaojh@ntuh.gov.tw.

PMID: 37871842
DOI: 10.1016/j.cgh.2023.09.040

Abstract

Background & aims: Hepatitis B surface antigen (HBsAg) seroclearance is the goal of functional cure for hepatitis B virus (HBV) infection. However, the impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on this favorable outcome remains unclear.

Methods: Patients with chronic hepatitis B (CHB) were consecutively recruited. MASLD was defined by the newly proposed disease criteria. Cumulative incidences and associated factors of HBsAg seroclearance/seroconversion were compared between the MASLD and non-MASLD groups.

Results: From 2006 to 2021, 4084 treatment-naive hepatitis B e antigen (HBeAg)-negative CHB patients were included. At baseline, CHB patients with concurrent MASLD (n = 887) had significantly lower levels of HBsAg and HBV DNA than the non-MASLD group (n = 3197). During a median follow-up of 5.0 years, MASLD was associated with a higher likelihood of HBsAg seroclearance (adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 1.10-1.85; P = .007), and the accumulation of individual metabolic dysfunctions additively facilitated HBsAg seroclearance. In addition, a higher rate of HBsAg seroconversion was observed in patients with MASLD versus those without MASLD (aHR, 1.37; 95% CI, 1.00-1.86; P = .049). In sensitivity analysis, patients with intermittent MASLD had an intermediate probability of HBsAg seroclearance. After balancing clinical and virologic profiles by inverse probability of treatment weighting (IPTW), MASLD was still associated with a higher HBsAg seroclearance rate (IPTW-adjusted HR, 1.41; 95% CI, 1.09-1.84; P = .010).

Conclusions: In untreated HBeAg-negative CHB patients, concurrent MASLD is associated with higher rates of HBsAg seroclearance and seroconversion. Metabolic dysfunctions have additive effects on the functional cure of CHB.

Keywords: Hepatitis B Virus (HBV); Metabolic Syndrome; Nonalcoholic Fatty Liver Disease (NAFLD); Steatosis.

MeSH terms

Antiviral Agents / therapeutic use
DNA, Viral / analysis
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Hepatitis B virus / genetics
Hepatitis B* / drug therapy
Hepatitis B, Chronic* / drug therapy
Humans
Seroconversion

Substances

Hepatitis B Surface Antigens
Hepatitis B e Antigens
DNA, Viral
Antiviral Agents