The Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Change in Liver Stiffness in Patients With Chronic Hepatitis B

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an increased risk of liver-related events in patients with chronic hepatitis B (CHB), possibly by accelerating fibrosis progression. Therefore, we studied the influence of MASLD on liver stiffness measurement (LSM) kinetics in CHB patients. Methods: We conducted a multicenter retrospective cohort study of CHB patients with at least two LSM with FibroScan. We studied the absolute change in LSM and the change in LSM stage from the first LSM to the most recent LSM among CHB patients with MASLD compared to patients without MASLD. Results: We analysed 1055 CHB patients; 259 (28.0%) had MASLD. Patients with MASLD had a higher first and last LSM (6.1 vs. 5.2 kPa and 5.6 vs. 4.7 kPa, p < 0.001), were significantly less likely to achieve a decrease in LSM stage (52.8% vs. 74% p < 0.001) and were more likely to experience an increase in LSM stage (19.3% vs. 13.6%, p = 0.035) during follow-up. 417 (39.5%) patients initiated antiviral therapy (AVT) which was associated with a decline in LSM (p < 0.001). However, patients with MASLD who were treated were less likely to decrease in LSM stage (52.4% vs. 77.0%, p < 0.001) and were more likely to experience an increase in LSM stage (23.5% vs. 12.8%, p = 0.021) despite AVT. Conclusion: Presence of MASLD was independently associated with higher LSM in untreated CHB patients and with less decline in LSM after initiation of AVT. Furthermore, CHB patients with MASLD were more likely to experience an increase in LSM despite AVT.