Met-HBV Diagnosis & Management with MASLD in Patients with Chronic HBV Infection (ondemand)-Met-HBV Webinar

Video Transcription

Video Summary

In this webinar led by Dr. Joseph Lim and colleagues, the intersection of metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic syndrome, and chronic hepatitis B virus (HBV) infection was discussed, an area of growing clinical importance. Two patient cases illustrated challenges in diagnosis and management. The first case involved a 46-year-old male with chronic HBV, obesity, and diabetes, presenting with moderate liver fibrosis and severe steatosis, leading to initiation of antiviral therapy after shared decision-making. The second case featured a 57-year-old female with chronic HBV on antivirals but persistent liver enzyme elevation and severe steatosis, managed with weight loss and later starting medications targeting MASLD.<br /><br />Key points highlighted include the high prevalence of MASLD and metabolic syndrome among chronic HBV patients globally, with variable impact on liver inflammation, fibrosis, and clinical outcomes. MASLD is associated with decreased HBV activity and increased likelihood of hepatitis B surface antigen seroclearance but may drive liver inflammation and fibrosis, especially when steatohepatitis is present. Metabolic syndrome is linked more consistently to adverse outcomes including cirrhosis, hepatocellular carcinoma (HCC), and mortality.<br /><br />Noninvasive tests like elastography and serum fibrosis assays are crucial for staging fibrosis, though cutoffs specific to HBV and MASLD dual diagnosis remain uncertain. Current guidelines suggest considering MASLD and metabolic risk factors in HBV antiviral treatment decisions, often via shared decision-making. Weight management, metabolic control (including glycemic optimization), and liver cancer surveillance are essential for patients with dual diagnoses.<br /><br />There is a lack of clinical trial data on MASLD therapies in HBV patients, but emerging treatments under study may soon provide options. Overall, the webinar emphasized a need for improved understanding, standardized definitions, and evidence-based guidance for managing chronic HBV patients with concurrent metabolic dysfunction and MASLD.

Keywords

Metabolic dysfunction-associated steatotic liver disease

MASLD

Metabolic syndrome

Chronic hepatitis B virus

HBV infection

Liver fibrosis

Steatosis

Antiviral therapy

Noninvasive fibrosis tests

Hepatocellular carcinoma