Severe Hepatic Steatosis is Associated with Low-Level Viremia and Advanced Fibrosis in Chronic Hepatitis B Patients in North America

ABSTRACT Background & Aims The obesity epidemic has increased the risk of non-alcoholic fatty liver disease (NAFLD) in both the general and chronic hepatitis B (CHB) populations. Our study aims to determine the prevalence of NAFLD in CHB patients based on controlled attenuation parameter (CAP), and the epidemiological, clinical and virological factors associated with severe hepatic steatosis. Methods The Canadian Hepatitis B Network cohort was utilized to provide a cross-sectional description of demographics, comorbidities, antiviral treatment, and HBV tests. Liver fibrosis and steatosis were measured by transient elastography (TE) and CAP, respectively. Any grade and severe steatosis were defined as CAP >248 and >280 dB/m, respectively. Advanced liver fibrosis was defined as TE measurement > 10.7kPa. Results In 1178 CHB patients (median age 47.4, 57.7% males, 75.7% Asian, 13% African, 6.5% White, 86% HBeAg negative, median HBV DNA of 2.44 log10IU/mL, 42.7% receiving treatment), the prevalence of any grade and severe steatosis was 53% and 36%, respectively. In the multivariate analysis, obesity was a significant predictor for severe steatosis (aOR 5.046, 95% CI: 1.22-20.93). Severe steatosis was a determinant associated with viral load (aOR 0.385, 95% CI: 0.20-0.75, p Conclusion In this large multi-ethnic CHB population, hepatic steatosis is common. Severe steatosis is independently associated with higher fibrosis, but negatively with HBV DNA, regardless of antiviral therapy history.