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Impact of Chronic Hepatitis B and Its Clinical Phases on Liver Fibrosis and Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease
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april 15 2026
Download the PDF here
Download the PDF here
Patients with concurrent CHB exhibited a more benign cardiometabolic profile. In the VCTE cohort, the CHB group had a significantly higher proportions of significant fibrosis (50.1% vs 33.5%), advanced fibrosis (25.4% vs 10.8%), and cirrhosis (15.7% vs 5.4%) (all P < .001) (Supplementary Figure 1). Similar trends were observed in the biopsy cohort (Supplementary Figure 2).
When restricting the analysis to treatment-naï
ve CHB, baseline characteristics of the VCTE cohort and the liver biopsy cohort are provided in Supplementary Table 2 and Table 1 , respectively. Among liver biopsy cohort, before PSM, those with treatment-naï
ve CHB had a lower prevalence of steatosis grades 2 (21.8% vs 32.4%) and 3 (6.8% vs 26.1%) but a higher inflammation grade ≥2 (60.3% vs 53.1%) compared with the MASLD-only group. They also had a lower prevalence of hypertension (11.2% vs 46.3%), lower BMI (25.42 vs 26.91 kg/m2), TGs (1.44 vs 1.90 mmol/L), and FPG (5.19 vs 5.52 mmol/L), but higher HDL-c (1.14 vs 1.10 mmol/L) (all P < .05) (Table 1). Before and after PSM, the treatment-naï
ve CHB group exhibited significantly higher proportions of significant fibrosis (before PSM: 50.9% vs 37.3%; after PSM: 48.9% vs 28.5%), advanced fibrosis (before PSM: 28.4% vs 12.7%; after PSM: 28.7% vs 10.4%), and cirrhosis (before PSM: 12.7% vs 3.9%; after PSM: 13.3% vs 2.9%) in the liver biopsy cohort (all P < .001) (Figure 2). Similar trends were observed in the VCTE cohort (Supplementary Figure 3,).
What You Need to Know
Background
The coexistence of chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming more common, but the impact of CHB on liver fibrosis/cirrhosis in patients with MASLD remains unclear.
Findings
Concurrent CHB was associated with increased risks of significant fibrosis, advanced fibrosis, and cirrhosis in patients with MASLD, not only in the immune-active phase but also in the gray-zone phase.
Implications for patient care
Patients with MASLD and concomitant active/gray-zone CHB should receive closer noninvasive monitoring and personalized management to prevent fibrosis progression and improve long-term outcomes.
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