Hepatic Steatosis in People With Chronic Hepatitis B in Africa: Prevalence, Correlates, and Clinical Significance

To address data gaps around metabolic liver disease in Africa, within the Hepatitis B in Africa Collaborative Network (HEPSANET), we evaluated participants with chronic hepatitis B virus infection (CHB) for steatotic liver disease (SLD) using transient elastography with controlled attenuation parameter (CAP). Using multivariable logistic regression, we identified sociodemographic, anthropometric, and clinical associations with SLD (CAP ≥ 248 dB/m), and evaluated whether SLD severity was independently associated with fibrosis. Short-term impacts of SLD on mortality were also assessed with Cox proportional hazards analysis. We also evaluated the diagnostic performance of B-mode ultrasound for SLD, with CAP as reference. Across 6 countries and 1601 participants (age range, 12-80 years; 39.5% female; 4% with diabetes; 11% unhealthy alcohol use; median body mass index, 24.4), 421 (26.3%) had SLD; 219 (13.7%) had severe steatosis (CAP ≥ 280 dB/m). Older age, male sex, overweight and obesity, and HIV-negative status were associated with SLD. After adjusting for age, sex, HIV status, HBV treatment, and country, severe steatosis, but not mild and moderate forms (i.e., 248-279 dB/m), was associated with a 8.4% (95%, 1.9%-14.9%) increased probability of fibrosis. Over limited follow-up (median 2.69 years) and small number of deaths, SLD was not associated with all-cause or liver-related mortality. B-mode ultrasound had low sensitivity for SLD, overall or when severe, but specificity was 95%. In conclusion, SLD was common in people with CHB in Africa and its severe form was associated with liver fibrosis. These data support screening for metabolic comorbidities as part of HBV care and treatment in Africa.