The importance and impact of recognizing MAFLD in patients with chronic hepatitis C

Background

Metabolic (dysfunction) associated fatty liver disease (MAFLD) can develop in any patient, including those with chronic hepatitis C (CHC). In this context, dual aetiology liver disease may have different characteristics and outcomes compared to those whose disease is secondary to a single aetiology. The recently proposed diagnostic criteria for MAFLD provide a unique opportunity to investigate the impact of concomitant fatty liver in patients with another cause for their liver disease.

Methods

We evaluated 1,181 patients including 744 with CHC and 437 with MAFLD. All patients on the two cohorts had a liver biopsy indicating disease activity and fibrosis stage.

Results

Nearly half (43.1%) of patients with CHC had concomitant MAFLD. Comparing CHC alone to patients having dual aetiology disease, the latter had worse hepatic liver injury, hepatic inflammation and fibrosis (all P <0.001). Interestingly, lean patients with CHC and MAFLD had similar fibrosis stage compared to the two other subgroups of MAFLD (obesity and/or Diabetes Mellitus). There was no statistical significance in hepatic steatosis and fibrosis between Genotype 3 of CHC and MAFLD group compared to other genotypes.

Conclusion

Chronic hepatitis C patients and concomitant MAFLD have more severe liver disease than those with viral hepatitis alone. Recognizing coexisting MAFLD in patients with CHC is important for the delivery of holistic care.

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