Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B

Chronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting abou...

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Main Authors: Saisai Zhang, Lung-Yi Mak, Man-Fung Yuen, Wai-Kay Seto
Format: Article
Language:English
Published: Korean Association for the Study of the Liver 2025-02-01
Series:Clinical and Molecular Hepatology
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Online Access:http://e-cmh.org/upload/pdf/cmh-2024-0837.pdf
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author Saisai Zhang
Lung-Yi Mak
Man-Fung Yuen
Wai-Kay Seto
author_facet Saisai Zhang
Lung-Yi Mak
Man-Fung Yuen
Wai-Kay Seto
author_sort Saisai Zhang
collection DOAJ
description Chronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting about one-third of CHB patients. The interaction between hepatic steatosis and CHB-related disease progression is complex and still under debate. Evidence demonstrates that co-existing steatosis may worsen liver fibrosis while paradoxically increasing the likelihood of achieving better HBV control. In particular, despite the association of steatotic liver disease (SLD) with lower HBV viral loads and higher rates of HBsAg seroclearance, the coexistence of CHB and SLD can potentially accelerate liver disease progression. Factors such as fat deposition, lipotoxicity, oxidative stress, and chronic inflammation in SLD may foster a pro-fibrotic and pro-carcinogenic environment, accelerating the disease progression. Additionally, loss of global DNA methylation, changes in the immune microenvironment, and genetic susceptibility further contribute to the development of CHB-related cirrhosis and hepatocellular carcinoma (HCC). This review examines the mechanisms driving liver disease progression and the heightened risk of cirrhosis and HCC in patients with concurrent CHB and steatotic liver disease, underscoring the importance of prioritizing antiviral therapy for CHB in addition to addressing SLD.
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spelling doaj-art-7bb693c2f24d43e3a2afe77dde38bb1a2025-08-20T03:06:09ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2025-02-0131SupplS182S19510.3350/cmh.2024.08372103Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis BSaisai Zhang0Lung-Yi Mak1Man-Fung Yuen2Wai-Kay Seto3 Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong KongChronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting about one-third of CHB patients. The interaction between hepatic steatosis and CHB-related disease progression is complex and still under debate. Evidence demonstrates that co-existing steatosis may worsen liver fibrosis while paradoxically increasing the likelihood of achieving better HBV control. In particular, despite the association of steatotic liver disease (SLD) with lower HBV viral loads and higher rates of HBsAg seroclearance, the coexistence of CHB and SLD can potentially accelerate liver disease progression. Factors such as fat deposition, lipotoxicity, oxidative stress, and chronic inflammation in SLD may foster a pro-fibrotic and pro-carcinogenic environment, accelerating the disease progression. Additionally, loss of global DNA methylation, changes in the immune microenvironment, and genetic susceptibility further contribute to the development of CHB-related cirrhosis and hepatocellular carcinoma (HCC). This review examines the mechanisms driving liver disease progression and the heightened risk of cirrhosis and HCC in patients with concurrent CHB and steatotic liver disease, underscoring the importance of prioritizing antiviral therapy for CHB in addition to addressing SLD.http://e-cmh.org/upload/pdf/cmh-2024-0837.pdfhepatitis b virusfatty livercirrhosishepatocellular carcinomanon-alcoholic fatty liver disease
spellingShingle Saisai Zhang
Lung-Yi Mak
Man-Fung Yuen
Wai-Kay Seto
Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
Clinical and Molecular Hepatology
hepatitis b virus
fatty liver
cirrhosis
hepatocellular carcinoma
non-alcoholic fatty liver disease
title Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
title_full Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
title_fullStr Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
title_full_unstemmed Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
title_short Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
title_sort mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis b
topic hepatitis b virus
fatty liver
cirrhosis
hepatocellular carcinoma
non-alcoholic fatty liver disease
url http://e-cmh.org/upload/pdf/cmh-2024-0837.pdf
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