Association of Metabolic Comorbidities With Fibrosis Severity and Fibrosis Regression in Patients With Chronic Hepatitis B

• Published in: Clinical gastroenterology and hepatology
• Main Authors: van Velsen, Lisa M., Patmore, Lesley A., Feld, Jordan J., Chan, Henry L.Y., Piratvisuth, Teerha, Chien, Rong-Nan, Dongelmans, Edo J., Pavlovic, Vedran, Yee, Leland J., Brouwer, Willem Pieter, Lau, Audrey, Hansen, Bettina E., Buti, Maria, Xie, Qing, Patel, Keyur, Fung, Scott K., Janssen, Harry L.A., Sonneveld, Milan J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.05.2025
• Subjects: Antiviral Therapy; Chronic Hepatitis B; Fibrosis Regression; Gastroenterology and Hepatology; Liver Biopsy; Chronic Hepatitis B; Liver Biopsy; aOR; CI; HBeAg; ALT; DM; HBsAg; HCC; IQR; MASLD; AUD; Fibrosis Regression; CHB; Antiviral Therapy; HBV; NUC; LRE; AVT; hepatitis B virus; alanine aminotransferase; alcohol use disorder; diabetes mellitus; interquartile range; adjusted odds ratio; hepatitis B e antigen; hepatocellular carcinoma; metabolic dysfunction–associated fatty liver disease; nucleos(t)ide analogue; hepatitis B surface antigen; liver-related event; confidence interval
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2025.04.024

The presence of metabolic comorbidities is associated with a higher risk of liver-related events in chronic hepatitis B (CHB) patients. However, the association between presence of metabolic comorbidities and the severity of biopsy-proven liver fibrosis is yet unknown. Data from CHB patients from 2 tertiary clinics and 8 clinical trials was analyzed. We studied the association between presence of metabolic comorbidities with severity of liver fibrosis in untreated patients, and with fibrosis regression or progression in biopsies taken after initiation of antiviral therapy. We analyzed biopsies from 3179 untreated CHB patients. Median age was 37 years, 57.6% were hepatitis B e antigen positive, with median hepatitis B virus DNA of 7.30 logIU/mL. Overweight (29.4% vs 19.0%; P < .001), hypertension (40.7% vs 23.2%; P < .001), diabetes (42.2% vs 23.6%; P < .001), and dyslipidemia (42.9 vs 23.6%; P < .001) were associated with a higher risk of advanced fibrosis, with the highest risk observed in patients with multiple comorbidities. Findings were consistent in multivariable analysis (1 comorbidity: adjusted odds ratio [aOR], 1.115; ≥2 comorbidities: aOR, 1.627; P = .006). Regression to nonadvanced fibrosis, after treatment initiation, was more often observed in patients without metabolic comorbidities (43.1%), compared with patients with 1 (31.6%) or ≥2 comorbidities (17.0%) (P = .005). Findings were consistent in multivariable analysis (1 comorbidity: aOR, 0.792; ≥2 comorbidities: aOR, 0.260; P = .025). The risk of progression to advanced fibrosis was highest in patients with ≥2 comorbidities (14.3% vs 4.6%; P = .001). Presence of metabolic comorbidities in untreated CHB patients is associated with more severe liver fibrosis and, after initiation of antiviral therapy, with less fibrosis regression and a higher risk of fibrosis progression. [Display omitted]