Diagnosis and management of metabolic dysfunction-associated steatohepatitis in patients with chronic hepatitis B infection

Chronic hepatitis B (CHB) infection is a global public health burden, affecting over 250 million persons globally, and is associated with substantial morbidity and mortality due to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Metabolic syndrome and metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly common co-morbidity among patients with CHB, affecting an estimated 25%-40% of individuals. The physiologic and clinical impact of co-existing CHB and metabolic syndrome and/or MASLD [met-hepatitis B virus (HBV)] is poorly understood, although recent data suggest important associations with poorer antiviral response and clinical outcomes. This review summarizes current and emerging evidence addressing this relationship, and outline recommendations for the diagnosis, risk stratification, staging, and management of Met-HBV.