Fatty liver is not independently associated with the rates of complete response to oral antiviral therapy in chronic hepatitis B patients

Abstract Background & aims Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are common liver diseases. Concurrent NAFLD may affect antiviral treatment outcomes in CHB patients. The aim of this study is to investigate the impact of NAFLD on complete viral suppression ([CVS], HBV DNA <20‐100 IU/mL) and/or biochemical response ([BR], ALT of ≤25 U/L for females; 35 U/L for males) in CHB patients who received oral antiviral therapy. Methods A retrospective study of 555 treated CHB patients (187 NAFLD; 368 non‐NAFLD) from 2000 to 2016 at a USA medical centre. NAFLD was diagnosed by imaging and/or histology after ruling out secondary causes of hepatic steatosis. Results The majority of patients were male (60.7%), Asian (87.56%) and HBeAg‐negative (66.7%). NAFLD patients compared to non‐NAFLD were more likely HBeAg negative (74.3% vs 62.8%, P = .02), hypertensive (33.2% vs 22.8%, P = .009) and male (67.4% vs 57.3%, P = .02) with a higher mean BMI (25.4 ± 4.3 vs 23.8 ± 4.0 kg/m 2 , P < .001). Both cohorts achieved similar rates of CVS (86% vs 88%) and BR (38% vs 41%) during the follow‐up of up to 60 months ( P > .05), but NAFLD had higher cumulative rates of CVS + BR, compared with non‐NAFLD patients (32.5% vs 22.8%, P = .03). In multivariate analyses, NAFLD was not independently associated with CVS and/or BR outcomes. Receipt of entecavir or tenofovir (vs older therapies) and lower baseline HBV DNA or higher ALT were positively associated with achieving CVS or BR. Conclusion Concomitant NAFLD had no impact on the long‐term rates of CVS and/or BR in treated CHB patients.