Diabetes, excess weight and other metabolic comorbidities increase the risk for adverse liver-related outcomes, such as liver cancer and transplantation among people living with chronic hepatitis B, according to findings published in Clinical Gastroenterology and Hepatology. What’s more, people with two or more of these conditions fared even worse.

Chronic hepatitis B virus (HBV) infection can cause liver fibrosis, which over time can progress to serious complications, including cirrhosis, liver cancer and the need for a liver transplant. Metabolic conditions, such as obesity, diabetes and high blood pressure, can worsen fibrosis. 

Lesley Patmore, MD, of Erasmus University Medical Center in the Netherlands, and colleagues assessed the link between metabolic comorbidities and clinical outcomes among people with chronic hepatitis B.  

The researchers carried out a retrospective cohort study that included people treated for chronic HBV infection at Erasmus University Medical Center and people with chronic hepatitis B who underwent liver biopsies at Toronto General Hospital in Canada.

The team took into account metabolic comorbidities, including overweight or obesity, diabetes, hypertension (high blood pressure) and dyslipidemia (abnormal blood fat levels). The primary study endpoint was the occurrence of hepatocellular carcinoma (the most common type of liver cancer), liver transplantation or liver-related death.

The study included 1,850 people. About 60% were men, the median age was 37 years and about 40% each were white and Asian. About half had overweight or obesity, 8.7% had hypertension, 6.3% had dyslipidemia and 4.4% had diabetes. About 10% had liver cirrhosis at baseline, and about 40% were receiving antiviral treatment for HBV.

Over a follow-up period of 7.3 years, 111 first events were observed. The incidence of liver cancer was 3.8%, liver transplantation was 2.3% and liver-related death was 2.3%. The overall cumulative incidence of liver-related events was 4.0% at five years and 6.9% at 10 years.

People with high blood pressure, diabetes, dyslipidemia and overweight or obesity were at greater risk for these events. Hypertension was associated with about an eightfold higher risk, diabetes with about a fivefold higher risk, dyslipidemia with nearly a threefold higher risk and overweight or obesity nearly doubled the risk.

The cumulative incidence of liver-related events was 4.2% at five years among people with one comorbidity, rising to 8.2% at 10 years. Multiple comorbidities led to an even greater risk: The cumulative incidence at five years and 10 years in people with two or more comorbidities was 14.8% and 21.8%, respectively. People with or without cirrhosis had a similar risk for these outcomes, and risk did not vary according to hepatitis B “e” antigen status, HBV viral load or use of antiviral therapy.

“Metabolic comorbidities in chronic hepatitis B patients are associated with an increased risk for liver-related events, with the highest risk observed in patients with multiple comorbidities,” wrote the researchers. “Findings were consistent in various clinically relevant subgroups, underscoring the need for thorough metabolic assessment in patients with chronic hepatitis B.”

Click here to read the study in Clinical Gastroenterology and Hepatology.
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