Impact of Hepatic Steatosis on Fibrosis and Treatment Response in Chronic Hepatitis B: a Longitudinal Cohort Study

Background and study aim: Data on the prevalence of NAFLD in chronic hepatitis B (CHB) patients is widely variable. Data about the effect of hepatic steatosis (HS) on CHB patients in the Middle East are scarce. So, we aimed to assess the associations between biopsy-proven HS and HBV viral load, liver biochemistry, and liver fibrosis and inflammation in CHB patients. We also aimed to evaluate the effect of HS on the complete virological response (CVR) within 2 years of follow-up. Patients and Methods: This hospital-based longitudinal cohort study included all CHB patients who were subjected to liver biopsy between June 2019 to June 2020. Patients were followed up for liver biochemistry and HBV DNA at six months’ intervals for two years. CVR was defined as undetectable HBV DNA by PCR testing 27 with a detection limit of 16 IU/ml as measured by the local laboratories. The baseline clinical characteristics and accumulative incidence of CVR were compared between patients with and without HS. Results: A total of 91 CHB patients were enrolled from June 2019 to June 2020. 43 (47%) of them had histological evidence of HS. Patients with chronic hepatitis had significantly higher body mass index (BMI) compared to patients with chronic infection. Patients with HS had higher HBV deoxyribonucleic acid (DNA) but without statistical significance. The severity of fibrosis was greater in HS group but without statistical significance. CVR at 6, 12, and 24 months after treatment onset was significantly higher in patients without HS (p = 0.01. 0.000,0.06, respectively). Conclusion: HS is highly prevalent in CHB patients. HS is not associated with HBV DNA or the severity of fibrosis. The rates of CVR are higher in CHB patients without HS.