Hepatic Steatosis in People With Chronic Hepatitis B in Africa: Prevalence, Correlates, and Clinical Significance

To address data gaps around metabolic liver disease in Africa, within the Hepatitis B in Africa Collaborative Network (HEPSANET), we evaluated participants with chronic hepatitis B virus infection (CHB) for steatotic liver disease (SLD) using transient elastography with controlled attenuation parameter (CAP). Using multivariable logistic regression, we identified sociodemographic, anthropometric, and clinical associations with SLD (CAP ≥ 248 dB/m), and evaluated whether SLD severity was independently associated with fibrosis. Short-term impacts of SLD on mortality were also assessed with Cox proportional hazards analysis. We also evaluated the diagnostic performance of B-mode ultrasound for SLD, with CAP as reference. Across 6 countries and 1601 participants (age range, 12-80 years; 39.5% female; 4% with diabetes; 11% unhealthy alcohol use; median body mass index, 24.4), 421 (26.3%) had SLD; 219 (13.7%) had severe steatosis (CAP ≥ 280 dB/m). Older age, male sex, overweight and obesity, and HIV-negative status were associated with SLD. After adjusting for age, sex, HIV status, HBV treatment, and country, severe steatosis, but not mild and moderate forms (i.e., 248-279 dB/m), was associated with a 8.4% (95%, 1.9%-14.9%) increased probability of fibrosis. Over limited follow-up (median 2.69 years) and small number of deaths, SLD was not associated with all-cause or liver-related mortality. B-mode ultrasound had low sensitivity for SLD, overall or when severe, but specificity was 95%. In conclusion, SLD was common in people with CHB in Africa and its severe form was associated with liver fibrosis. These data support screening for metabolic comorbidities as part of HBV care and treatment in Africa.

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Publication Details

Journal
Journal of Viral Hepatitis
Published
2026-10-04
DOI
https://doi.org/10.1111/jvh.70241
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
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article

Hepatic Steatosis in People With Chronic Hepatitis B in Africa: Prevalence, Correlates, and Clinical Significance

Alexander J. Stockdale, Michael J. Vinikoor, Maud Lemoine, Abdoul Sow et al.
Journal of Viral Hepatitis
Liver Disease Diagnosis and Treatment
article

Hepatic Steatosis in People With Chronic Hepatitis B in Africa: Prevalence, Correlates, and Clinical Significance

Alexander J. Stockdale, Michael J. Vinikoor, Maud Lemoine, Abdoul Sow, C Wendy Spearman, Alice Nanelin Guingané, Edford Sinkala, Alana T. Brennan, Asgeir Johannessen, Philippa Clare Matthews, Juste Aristide Goungounga, Mark Wayne Sonderup, I. Diallo, W Freeman, Attah Okwute, Amy Miskimon Goss, Roger Sombié, Hans Walter Prozesky, Zahiera Ismail, Lamin Bojang, Hailemichael Desalegn, Judicaël Malick Tine, Edith Nonyelum Okeke, Arouna Sessouma, Yusupha Samateh, Eman Marwan, Mohamed El-Kassas, Hepatitis B in Africa Collaborative Network (HEPSANET)
article en

Abstract

To address data gaps around metabolic liver disease in Africa, within the Hepatitis B in Africa Collaborative Network (HEPSANET), we evaluated participants with chronic hepatitis B virus infection (CHB) for steatotic liver disease (SLD) using transient elastography with controlled attenuation parameter (CAP). Using multivariable logistic regression, we identified sociodemographic, anthropometric, and clinical associations with SLD (CAP ≥ 248 dB/m), and evaluated whether SLD severity was independently associated with fibrosis. Short-term impacts of SLD on mortality were also assessed with Cox proportional hazards analysis. We also evaluated the diagnostic performance of B-mode ultrasound for SLD, with CAP as reference. Across 6 countries and 1601 participants (age range, 12-80 years; 39.5% female; 4% with diabetes; 11% unhealthy alcohol use; median body mass index, 24.4), 421 (26.3%) had SLD; 219 (13.7%) had severe steatosis (CAP ≥ 280 dB/m). Older age, male sex, overweight and obesity, and HIV-negative status were associated with SLD. After adjusting for age, sex, HIV status, HBV treatment, and country, severe steatosis, but not mild and moderate forms (i.e., 248-279 dB/m), was associated with a 8.4% (95%, 1.9%-14.9%) increased probability of fibrosis. Over limited follow-up (median 2.69 years) and small number of deaths, SLD was not associated with all-cause or liver-related mortality. B-mode ultrasound had low sensitivity for SLD, overall or when severe, but specificity was 95%. In conclusion, SLD was common in people with CHB in Africa and its severe form was associated with liver fibrosis. These data support screening for metabolic comorbidities as part of HBV care and treatment in Africa.

Journal of Viral HepatitisVol. 33(11)
Boston University (US), Centre for Infectious Disease Research in Zambia (ZM), Centre National de la Recherche Scientifique (FR), Université Joseph Ki-Zerbo (BF), University Health Network (CA), Cairo University (EG), University of Liverpool (GB), Inserm (FR), University of Cape Town (ZA), University of Oslo (NO), University of the Witwatersrand (ZA), Stellenbosch University (ZA), Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MW), The Francis Crick Institute (GB), Sykehuset i Vestfold (NO), Tygerberg Hospital (ZA), University of Alabama at Birmingham (US), University of Zambia (ZM), MRC Unit the Gambia (GM), Centre Hospitalier Universitaire Yalgado Ouédraogo (BF), Centre Hospitalier National Universitaire de Fann (SN), Hôpital Principal de Dakar (SN), Jos University Teaching Hospital (NG), St. Paul's Hospital Millennium Medical College (ET), Levy Mwanawasa Medical University (ZM), University College London (GB), Imperial College London (GB), Université de Rennes (FR), Cheikh Anta Diop University (SN)
Openalex Percentile: Top 11%
Liver Disease Diagnosis and Treatment
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