From HBV to MASLD Cirrhosis: Mechanistic Insights and Therapeutic Strategies

ABSTRACT The global landscape of liver cirrhosis has undergone a significant transformation with the widespread implementation of viral vaccines, and metabolic dysfunction‐associated steatotic liver disease (MASLD) cirrhosis has emerged as a predominant etiology. Given the differences in the pathogenic mechanisms between viral and MASLD cirrhosis, conventional diagnostic and therapeutic strategies for viral cirrhosis have demonstrated limited applicability in MASLD cirrhosis. The pathogenesis of MASLD cirrhosis involves multifaceted interactions between metabolic dysregulation, inflammatory responses, immune dysregulation, and gut–liver axis disruption, presenting substantial challenges in clinical management. Although liver biopsy remains the gold standard for diagnosis, complications, including hemorrhage, infection, pain, and pneumothorax, lead to suboptimal patient compliance, thereby prompting the development of various noninvasive diagnostic tools. Current therapeutic approaches primarily target key pathological mechanisms through metabolic regulation of glucose and lipid homeostasis, inflammation control, and microbial balance restoration. This review summarized the epidemiological transition from viral to MASLD cirrhosis and aimed to provide a conceptual framework for optimizing diagnostic and therapeutic strategies in the MASLD era.