Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are both significant contributors to liver-related complications and mortality. Dr. Youwen Tan’s team at the Third People’s Hospital of Jiangsu University conducted research on the impact of NAFLD, as confirmed by liver histopathology, and pathological changes on individuals with chronic HBV infection. The latest research findings were selected for presentation at the 58th Annual Meeting of the European Association for the Study of the Liver (EASL 2023) and the EASL Congress 2023.
As the prevalence of NAFLD increases, the number of individuals with coexisting non-alcoholic fatty liver disease (NAFLD) and hepatitis B virus (HBV) infection is also on the rise. In the Asian region, the prevalence of NAFLD in the HBV-infected population ranges from 14% to 67%, which is not significantly different from Western countries. In recent years, there has been extensive research on the coexistence of hepatitis B and NAFLD; however, the interaction between these two diseases remains complex. While many studies have investigated the impact of chronic HBV infection and NAFLD on liver disease, there have been few studies focusing on the prognosis of NAFLD as defined by liver histopathology in individuals with chronic HBV infection. This study aimed to further explore the effects of histopathologically confirmed NAFLD and pathological changes on individuals with chronic HBV infection.
The study collected data from chronic HBV-infected individuals who underwent liver biopsies at the Third People’s Hospital of Jiangsu University between January 2005 and September 2020. A total of 456 chronic HBV-infected individuals were included in the study, among whom 152 (33.3%) were confirmed to have histopathological NAFLD. The median follow-up time for the entire cohort was 70.5 months. Excluding 67 individuals with baseline cirrhosis, a total of 34 individuals developed ultrasound-diagnosed cirrhosis during the follow-up period. Kaplan-Meier survival analysis revealed no significant correlation between the presence of NAFLD and the risk of cirrhosis (log-rank, P > 0.05), as shown in Figure 1. Cirrhosis was more likely to occur in CHB patients with baseline fibrosis (log-rank, P = 0.046). After propensity score matching (PSM), multifactorial analysis showed that diabetes, hepatocyte ballooning, and platelet count (PLT) were independent risk factors for the occurrence of ultrasound-diagnosed cirrhosis (P < 0.05).
A total of 10 individuals (2.2%) developed hepatocellular carcinoma (HCC), with 6 cases in the group with coexisting NAFLD. The median time interval between liver biopsy and HCC diagnosis was 100.5 months. Kaplan-Meier survival analysis demonstrated a significantly increased cumulative risk of HCC in the group with coexisting NAFLD (log-rank, P < 0.05), as depicted in Figure 2. Lobular inflammation, hepatocyte ballooning, and severe liver fibrosis were also associated with an increased risk of HCC (log-rank, P < 0.05). Cox multivariate analysis revealed that hepatocyte ballooning, liver fibrosis, and diabetes were independent risk factors for HCC occurrence.
In conclusion, coexisting NAFLD did not show a significant correlation with the development of cirrhosis in individuals with chronic HBV infection. Diabetes, hepatocyte ballooning, and platelet count were independent risk factors for cirrhosis development. Chronic HBV-infected individuals with coexisting NASH had an increased risk of developing HCC. Hepatocyte ballooning, liver fibrosis, and diabetes were independent risk factors for HCC occurrence.
Youwen Tan
Director of Hepatology, Third People’s Hospital of Jiangsu University
