Background: Both CHB and fatty liver are common problems, and some patients may have both diseases together. The interaction between these two diseases is still not clear in relation to its effect on liver disease severity and hepatitis B treatment efficacy.

Objective: To study the prevalence of fatty liver in patients with chronic hepatitis B infection and identify factors associated with this condition including host factors, viral factors, and associations with liver disease severity.

Materials and Methods: Data were collected retrospectively from patients with chronic Hepatitis B between 2014 and 2017 in Rajavithi Hospital, Bangkok, Thailand. Demographic information, was recorded including physical examination data, biochemical data and HBV DNA levels, transient elastography and fat content in liver assessed by the controlled attenuation parameter technique (CAP). Data analysis was performed to assess the prevalence of fatty liver and clinical correlations between fatty liver and patient
parameters, viral parameters and liver status.

Results: Of the 206 patients included, 86 patients (41.7%) were men; the mean body mass index (BMI) was 23.92+3.88 kg/m2; 7.8% were obese (BMI >30 kg/m2); and the mean age was 50.01+12.39 years. Most patients (81.6%) were aged less than 40 years; 73.3% had ALT <40 IU/ml; 83% had HBeAg negative; and 57.3% had HBV DNA level of more than 1,999 IU/ml. The prevalence of fatty liver in patients with chronic hepatitis B infection was 57.8%, and 10.2% had severe fatty liver (S3). Fatty liver in CHB infection was
associated with male gender (p = 0.032), high BMI (p<0.001), high ALT level (p = 0.003) and high AST level (p = 0.020), but was not correlated with HBV DNA viral load, HBeAg status or liver stiffness. Multivariate analysis found that male gender and high BMI were associated with fatty liver in CHB infection with OR = 2.28, 95% CI: 1.21 to 4.30, p = 0.010 and OR = 2.28, 95% CI: 1.21 to 4.30, p = 0.010, respectively.

Conclusion: Fatty liver is common in patients with CHB infection and is related to male gender and high BMI. Liver fibrosis and cirrhosis were found in a significant portion of patients but were not related to fatty liver. Viral factors, rather than fatty liver itself, play a major role in liver necroinflammation and fibrosis.

Keywords: Chronic hepatitis B (CHB), HBeAg, HBV DNA level, AST, ALT, Fatty liver, Body mass index (BMI), Transient elastography (Fibroscan), Liver Stiffness measurement (LSM), Controlled attenuation parameter technique (CAP)