Chronic hepatitis B-associated liver disease in the context of human immunodeficiency virus co-infection and underlying metabolic syndrome

Abstract

Globally, a shift in the epidemiology of chronic liver disease has been observed. This has been mainly driven by a marked decline in the prevalence of chronic hepatitis B virus infection (CHB), with the greatest burden restricted to the Western Pacific and sub-Saharan African regions. Amidst this is a growing burden of metabolic syndrome (MetS) worldwide. A disproportionate co-burden of human immunodeficiency virus (HIV) infection is also reported in sub-Saharan Africa, which poses a further risk of liver-related morbidity and mortality in the region. We reviewed the existing evidence base to improve current understanding of the effect of underlying MetS on the development and progression of chronic liver disease during CHB and HIV co-infection. While the mechanistic association between CHB and MetS remains poorly resolved, the evidence suggests that MetS may have an additive effect on the liver damage caused by CHB. Among HIV infected individuals, MetS-associated liver disease is emerging as an important cause of non-AIDS related morbidity and mortality despite antiretroviral therapy (ART). It is plausible that underlying MetS may lead to adverse outcomes among those with concomitant CHB and HIV co-infection. However, this remains to be explored through rigorous longitudinal studies, especially in sub-Saharan Africa. Ultimately, there is a need for a comprehensive package of care that integrates ART programs with routine screening for MetS and promotion of lifestyle modification to ensure an improved quality of life among CHB and HIV co-infected individuals.

Keywords: Hepatitis B virus, Human immunodeficiency virus, Metabolic syndrome, Fatty liver disease, Chronic liver disease, Sub-Sharan Africa

Core Tip: Independently, chronic hepatitis B virus (HBV) infection, human immunodeficiency virus (HIV) infection and metabolic syndrome (MetS) are known risk factors of chronic liver disease. The presence of MetS components, including type 2 diabetes mellitus, central obesity and lipid abnormalities, are associated with adverse outcomes and altered treatment response among HBV and HIV infected individuals. While underlying MetS may have an additive effect on the development and progression of chronic liver disease among HBV-HIV co-infected individuals, the evidence from endemic regions like sub-Saharan Africa is limited and deserves further attention in the research agenda.