The role of hepatic steatosis in chronic hepatitis B infection

Chronic hepatitis B (CHB) infection is a global public health burden, and is associated with substantial morbidity and mortality. Although viral factors such as hepatitis B virus (HBV) DNA, hepatitis B e antigen, and genotype are known determinants of risk for histologic progression and hepatocellular carcinoma (HCC), other host factors can also play key roles. Hepatic steatosis (fatty liver) is increasingly common in the general population as a reflection of a rising prevalence of obesity in both Western and Eastern countries. Whereas the impact of superimposed hepatic steatosis on chronic hepatitis C infection is well-described, its role in the natural history, management, and clinical outcomes of CHB remains less defined. This article summarizes existing evidence on the prevalence and risk factors for hepatic steatosis in CHB, proposed pathogenetic links between HBV and hepatic steatosis, impact on the risk for liver fibrosis and HCC, and implications for antiviral therapy. © 2011 Springer Science+Business Media, LLC.