Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2019; 25(3): 282-286
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.282
Chronic hepatitis B and metabolic risk factors: A call for rigorous longitudinal studies
Wai-Kay Seto
Wai-Kay Seto, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Wai-Kay Seto, Department of Medicine, the University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Wai-Kay Seto, State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Author contributions: Seto WK interpreted the literature and wrote the manuscript.
Conflict-of-interest statement: Wai-Kay Seto is an advisory board member and received speaker’s fees from AbbVie; he is also an advisory board member, received speaker’s fees and research funding from Gilead Sciences.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wai-Kay Seto, FRCP (C), MBBS, MD, Associate Professor, Doctor, Department of Medicine, the University of Hong Kong Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. wkseto@hku.hk
Telephone: +86-852-22553994 Fax: +86-852-28162863
Received: August 29, 2018
Peer-review started: August 29, 2018
First decision: October 9, 2018
Revised: October 14, 2018
Accepted: October 21, 2018
Article in press: October 21, 2018
Published online: January 21, 2019

Long-term nucleos(t)ide analogue therapy in chronic hepatitis B virus (HBV) infection is effective in suppressing viral replication and reducing liver-related complications. However, HBV-related liver events can still occur in different patient sub-groups. There is emerging evidence that, similar to chronic hepatitis C virus infection, metabolic risk factors may play a role in the disease process of chronic HBV. While the mechanistic nature of metabolic-HBV interactions remains uncertain, studies in different HBV-infected populations have demonstrated that hepatic steatosis, increased body-mass index, diabetes, or a combination of different metabolic risk factors are associated with an increased risk of hepatocellular carcinoma and cirrhosis. The impact of metabolic risk factors is especially prominent in patients with quiescent virological activity, including on-treatment patients with effective viral suppression. As the proportion of on-treatment chronic HBV patients increases worldwide, longitudinal studies determining the relative risks of different metabolic parameters with respect to clinical outcomes are needed. Future studies should also determine if metabolic-directed interventions can improve disease outcomes in chronic HBV.

Keywords: Hepatitis B virus, Diabetes, Obesity, Steatosis, Non-alcoholic fatty liver disease, Body-mass index

Core tip: Metabolic risk factors, including hepatic steatosis, increased body-mass index and diabetes, may be associated with worsened disease outcomes and reduced treatment response in chronic hepatitis B. Their effect may be most pronounced in patients with quiescent viral activity, including patients on long-term nucleos(t)ide analogue therapy.