Abstract

Introduction: Hepatic steatosis and chronic hepatitis B virus (HBV) infection are major global health concerns, particularly in regions with high HBV endemicity. Both conditions contribute significantly to liver dysfunction, yet their coexistence and potential interaction remain poorly understood. This study aims to investigate the prevalence of hepatic steatosis among patients with chronic HBV infection and to examine the relationship between hepatic steatosis and HBV viral activity.
Methods: A cross-sectional study was conducted at Bizerte’s University Hospital, involving patients with confirmed chronic HBV infection. Data collected included demographic information, metabolic risk factors, body mass index (BMI), liver function tests, HBV DNA levels, and hepatitis B e antigen (HBeAg) status. Hepatic steatosis was assessed using controlled attenuation parameter (CAP) via transient elastography. Statistical analysis was performed using SPSS version 26.
Results: The study included 50 patients (sex ratio M/F = 1.5), with a mean age of 46.2 ± 14.8 years and a mean BMI of 27.0 ± 5.3 kg/m². Of the 50 HBV-positive patients, 90% were found to have hepatic steatosis, with 40% having mild (S1), 30% moderate (S2), and 20% severe (S3) steatosis. Notably, patients with hepatic steatosis had a significantly higher BMI.
Pearson’s chi-square analysis revealed a statistically significant association between hepatic steatosis and HBV DNA levels (χ² (10, N = 50) = 33.25, p < 0.001). Analysis of variance (ANOVA) further showed a significant correlation between the degree of hepatic steatosis and the level of liver fibrosis (F = 5.154, p = 0.009). A linear relationship was identified (p = 0.002), with no significant deviation from linearity (p = 1.000), suggesting that increased fibrosis severity is associated with the presence of steatosis.
No significant association was found between hepatic steatosis and HBeAg status (F = 0.113, p = 0.738). T-tests revealed significant differences in BMI (p < 0.001), Gaj (p = 0.001), and triglycerides (TG) (p = 0.045), with lower average values in patients without steatosis. No significant differences were observed for ALT (p = 0.095), total cholesterol (p = 0.790), or HBV DNA levels (p = 0.169).
Conclusion: Hepatic steatosis is highly prevalent among patients with chronic HBV, particularly in those with metabolic risk factors. The inverse relationship between steatosis and HBV replication suggests a complex interplay that warrants further investigation. These findings underscore the importance of metabolic screening and management as part of comprehensive care for individuals with chronic HBV infection, to improve long-term liver health outcomes.

Keywords

Hepatitis B, Hepatic Steatosis, Metabolic Disorders, Non alcoholic Fatty Liver Disease, Disease Burden, Viral Load, Fibrosis