Association Found Between MAFLD and Patients With Chronic HBV-related HCC

In 2020, the international medical community changed the definition of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) because it reflected metabolic abnormalities more closely associated with cardiovascular risk.

In a recently released study, Chinese physicians have found an association between MAFLD and the prognosis for patients with chronic hepatitis B-related hepatocellular carcinoma (HCC). Published online in August by Dove Medical Press, the retrospective study found that HBV-related HCC patients with MAFLD had better outcomes than patients who did not have MAFLD.

“Risk factors for HCC, such as positive HBeAg, high load of HBV DNA, and metabolic traits, do not have a significant effect on the MAFLD group,” wrote the authors. “A novel finding was that patients with MAFLD achieved better survival among HCC patients with HBV infection, which may be due to the interaction between steatosis and virus replication.”

HBV infects an estimated 300 million people globally, including 6 million children under the age of five, according to the CDC. The chronic disease increases the risk of liver cirrhosis and HCC. Roughly 1 million people a year die from HBV-related liver disease, mostly among poor and marginalized populations in Africa and Southeast Asia, according to the WHO.

HBV is usually asymptomatic until liver disease has progressed and is untreatable. An effective vaccine has been available since 1980. But the vaccine must be administered within 24 hours of birth, followed by two to three additional doses for life-long protection.

Current antiviral therapies for HBV can suppress the virus, but often cause serious side effects and are largely ineffective. Moreover, many of the people with HBV cannot access consistent therapy, according to the WHO.

The study analyzed the records of 624 patients hospitalized with HCC between 2012 and 2020. The median age of the mostly male patients (83.3%) was 57 years old, and the most common cause of HCC was chronic HBV. Patients had regular follow-ups every three months during the first year, and three- to-six months thereafter.

In their report, the authors noted there is “substantial epidemiological evidence” that being overweight is associated with an increased risk of HCC as well as an overall higher all-cause mortality risk than normal body weight. Yet, patients in the study with HCC whose body mass index was higher had “a significantly lower” risk of death.

“Patients with lean NAFLD are at a higher risk of developing severe liver disease and worse outcomes of HCC despite having a better histological and metabolic profile,” the study reported. “However, our stratified analyses determined that both lean and overweight patients with MAFLD achieved a significant improvement in the clinical outcome of HCC.”

The physicians speculate that the reason HCC patients with HBV infection have less severe liver disease and worse outcomes may be the heterogeneity of MAFLD influenced by multiple factors including age, sex, surveillance, alcohol intake, viral infection, and metabolic status.

“In addition, multivariate analysis indicated that MAFLD was an independent favorable prognostic factor for patients with CHB-HCC,” the authors added. “Moreover, the subgroup analyses defined by metabolic characteristics further confirm these findings.”