title: Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B.
abstract: BACKGROUND
  The coexistence of HBV infection and nonalcoholic fatty liver disease (NAFLD) becomes characteristic of liver disease in China, with unknown bilateral influence. We aimed to investigate the effect of hepatic steatosis, a common hepatocyte change in NAFLD, on antiviral therapy in patients with chronic hepatitis B (CHB).
  
  
  RESULTS
  We carried out a prospective nested case control study in CHB patients receiving Entecavir for initial antiviral therapy, by recording demographic, anthropometric and clinical data at baseline, 24(wk), 48(wk) and 96(wk). Univariate analysis and multivariate logistic regression were applied to find out independent factors of hepatic steatosis and Entecavir treatment failure. The rates of HBV-DNA clearance, HBeAg seroconversion and ALT normalization were compared between CHB patients with and without steatosis by post hoc analysis. A total of 267 Chinese patients with CHB entered final analysis, with overall percentages of hepatic steatosis and HBeAg positive as 30.5% and 62.4%. Multivariate analysis showed waist circumference, serum TG and uric acid levels were independent factors of hepatic steatosis. The response rates to Entecavir were 54.9%, 63.8%, 74.2% at 24(wk), 48(wk) and 96(wk). Hepatic steatosis was revealed as an independent factor of Entecavir treatment failure by multivariate logistic regression at 24(wk), 48(wk) and 96(wk). In CHB patients with hepatic steatosis, HBV-DNA clearance and HBeAg seroconversion were both lower throughout the follow-up, but only the former reached statistical significance. Besides, ALT normalization was also significantly lower at 24(wk) and 48(wk).
  
  
  CONCLUSIONS
  Hepatic steatosis is significantly associated with Entecavir treatment failure and metabolic factors are independent factors of hepatic steatosis in CHB patients, which called for a specified antiviral strategy in CHB patients with NAFLD.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. jxfl007@hotmail.com
authors.forename: Xi
authors.initials: X
authors.lastname: Jin
authors.forename: Yi-peng
authors.initials: YP
authors.lastname: Chen
authors.forename: Yi-da
authors.initials: YD
authors.lastname: Yang
authors.forename: You-ming
authors.initials: YM
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Zheng
authors.forename: Chuan-qing
authors.initials: CQ
authors.lastname: Xu
mesh_terms: D000328:Adult; D000886:Anthropometry; D000998:Antiviral Agents / Q000627:therapeutic use; D015992:Body Mass Index; D016022:Case-Control Studies; D002681:China; D005234:Fatty Liver / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy*; D022781:Hepatocytes / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; C413685:entecavir; D006147:Guanine