title: The prevalence of steatohepatitis in chronic hepatitis B patients and its impact on disease severity and treatment response.
abstract: The clinical significance of steatohepatitis in chronic hepatitis B remains unclear. This study aimed to determine the prevalence and risk factors for steatohepatitis in chronic hepatitis B, and to determine its correlation with liver fibrosis and response to antiviral therapy.
  
  
  
  Liver histopathology of 256 consecutive chronic hepatitis B patients with serum hepatitis B virus DNA >2000 IU/mL were analysed with clinical and laboratory characteristics. Virological and biochemical responses were prospectively assessed in the 112 patients treated with antiviral monotherapy.
  
  
  
  Hepatic steatosis was observed in 38% of the entire cohort, and steatohepatitis was diagnosed in 18% of patients with hepatic steatosis according to Brunt's classification. The presence of steatohepatitis was associated with overweight/obese (odds ratio, 5.99; 95% CI, 1.32-27.2) and hypertriglyceridaemia (odds ratio, 2.95; 95% CI, 1.07-8.15). None of the viral characteristics including HBeAg status, genotypes and viraemia levels was associated with the presence of steatohepatitis. Steatohepatitis was an independent predictor of significant fibrosis (odds ratio, 10.0; 95% CI, 2.08-48.5) and advanced fibrosis (odds ratio, 3.45; 95% CI, 1.11-10.7) after adjusting for viraemia levels and features of the metabolic syndrome. The rates of suppression of serum hepatitis B virus DNA <20 IU/mL combined with aminotransferase normalization at week 48 of antiviral therapy were not different between the steatohepatitis and non-steatohepatitis groups (43% vs 53%; P=.475).
  
  
  
  Steatohepatitis is not uncommon in chronic hepatitis B patients. It is associated with metabolic syndrome but not viral factor. This study demonstrates that steatohepatitis is related to the severity of liver fibrosis but it does not affect response to antiviral therapy.
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Phunchai
authors.initials: P
authors.lastname: Charatcharoenwitthaya
authors.affiliation: Faculty of Medicine, Department of Pathology, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Ananya
authors.initials: A
authors.lastname: Pongpaibul
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Uayporn
authors.initials: U
authors.lastname: Kaosombatwattana
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Patommatat
authors.initials: P
authors.lastname: Bhanthumkomol
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Wimolrak
authors.initials: W
authors.lastname: Bandidniyamanon
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Nonthalee
authors.initials: N
authors.lastname: Pausawasdi
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Tawesak
authors.initials: T
authors.lastname: Tanwandee
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005234:Fatty Liver / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D016174:Hepacivirus; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D000072230:Sustained Virologic Response; D013785:Thailand / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral
keywords: Steatohepatitis; antiviral therapy; hepatitis B; liver fibrosis; metabolic syndrome