Liver and Bile
Eur J Gastroenterol Hepatol. 2023;35(3):294–301
Positive hepatitis B core antibody is associated with advanced fibrosis and mortality in non-alcoholic fatty liver disease
Objective: Concomitant hepatitis B virus infection and non-alcoholic fatty liver disease (NAFLD) are relatively common, while little is known about the impact of anti-hepatitis B core antibody (anti-HBc) on NAFLD individuals. The authors aimed to investigate the association of positive anti-HBc with advanced fibrosis and mortality in NAFLD.
Methods: They analyzed data from 3268 NAFLD participants who underwent abdominal ultrasonography during the Third National Health and Nutrition Examination Survey (NHANES III). The Fibrosis-4 (FIB-4) score > 2.67, NAFLD fibrosis score > 0.676, or aspartate aminotransferase to platelet ratio index > 1.5 were defined as advanced fibrosis. All-cause and cause-specific mortality were obtained from the NHANES III-linked follow-up file through December 31, 2015.
Results: A total of 242 patients (7.4%) had positive anti-HBc. Patients with positive anti-HBc had a higher percentage of advanced fibrosis than those with negative anti-HBc (12.2% vs. 5.8%). Positive anti-HBc was significantly associated with advanced fibrosis (adjusted odds ratio = 1.69, 95% confidence interval [CI]: 1.05–2.72). During a median follow-up of 22 years, the cumulative all-cause and cancer-related mortalities were higher in participants with positive anti-HBc than in their counterparts (log-rank test p < 0.001). When demographic and metabolic risk factors were considered, NAFLD cases with positive anti-HBc had a significantly higher cancer-related mortality (adjusted hazard ratio = 1.54, 95% CI: 1.05–2.25).
Conclusion: These findings suggested that non-alcoholic fatty liver disease (NAFLD) cases with positive anti-hepatitis B core antibody (anti-HBc) had higher risks for liver fibrosis and long-term mortality, justifying the medical importance of testing anti-HBc in NAFLD patients.