Chronic Viral Hepatitis B and C Outweigh MASLD in the Associated Risk of Cirrhosis and HCC

Mei-Hsuan Lee; Yi-Ting Chen; Yu-Han Huang; Sheng-Nan Lu; Tsai-Hsuan Yang; Jee-Fu Huang; Szu-Ching Yin; Ming-Lun Yeh; Chung-Feng Huang; Chia-Yen Dai; Wan-Long Chuang; Ming-Lung Yu; Hwai-I Yang; Hsuan-Yu Chen; Chien-Jen Chen

doi:10.1016/j.cgh.2024.01.045

Chronic Viral Hepatitis B and C Outweigh MASLD in the Associated Risk of Cirrhosis and HCC

Clin Gastroenterol Hepatol. 2024 Feb 15:S1542-3565(24)00198-8. doi: 10.1016/j.cgh.2024.01.045. Online ahead of print.

Authors

Affiliations

¹ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Advanced Therapeutics Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Master of Public Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: meihlee@nycu.edu.tw.
² Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
⁴ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁶ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan.
⁷ Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
⁸ Genomics Research Center, Academia Sinica, Taipei, Taiwan.

PMID: 38365094
DOI: 10.1016/j.cgh.2024.01.045

Abstract

Background & aims: The impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on the development of cirrhosis and hepatocellular carcinoma (HCC) by chronic hepatitis B (CHB) or C infection and antiviral treatment statuses is not well-known.

Methods: A total of 336,866 adults aged ≥30 years were prospectively enrolled in a health screening program between 1997-2013. MASLD was identified by abdominal ultrasonography and cardiometabolic profiles. Data linkage was performed using 3 nationwide databases-National Health Insurance, Cancer Registry, and Death Certification System-to obtain information on antiviral treatment, vital status, and newly diagnosed cirrhosis and HCC. Follow-up was conducted until December 31, 2019.

Results: In the total population, 122,669 (36.4%) had MASLD. Over a mean follow-up of 15 years, 5562 new cases of cirrhosis and 2273 new cases of HCC were diagnosed. Although MASLD significantly increased the cumulative risks of cirrhosis or HCC (P < .0001), the associated risk was more pronounced when comparing CHB or C infection with the presence of MASLD. Stratifying the participants based on their MASLD and CHB or C statuses, hazard ratios (HR_adj) with 95% confidence intervals for HCC were 8.81 (7.83-9.92) for non-steatotic liver disease (SLD) with CHB or C, 1.52 (1.32-1.74) for MASLD without CHB or C, and 8.86 (7.76-10.12) for MASLD with CHB or C, compared with non-SLD without CHB or C (all P < .0001). Among CHB or C patients who received antivirals during follow-up, MASLD was associated with increased risks of cirrhosis and HCC, with HR_adj of 1.23 (1.01-1.49) and 1.32 (1.05-1.65), respectively.

Conclusions: These findings underscore the need to prioritize treatment of chronic viral hepatitis before addressing MASLD.

Keywords: Antiviral Treatment; Chronic Viral Hepatitis; End-Stage Liver Disease; Fatty Liver Disease; Long-Term Risk.