Chronic Viral Hepatitis With MASLD: Implications for Clinical and Patient‐Reported Outcomes

BACKGROUND: Hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction-associated steatotic liver disease (MASLD) are common liver diseases. Clinical characteristics and patient-reported outcomes (PROs) of HBV and HCV patients with/without superimposed MASLD were evaluated. METHODS: Cross-sectional study of clinical and PRO (FACIT-Fatigue [FACIT-F], Chronic Liver Disease Questionnaire [CLDQ], Work Productivity and Activity Impairment [WPAI] questionnaire) data from Global Liver Registry, HBV and HCV patients. MASLD was defined as Hepatic Steatosis Index (HSI) ≥ 36 with ≥ 1 cardiometabolic risk factor (overweight, type 2 diabetes, hypertension, and hyperlipidemia). RESULTS: Among 4649 subjects, 2063 had HBV (48 ± 13 years; 57% male; 11% advanced fibrosis; 49% MASLD); 2586 had HCV (56 ± 14 years; 47% male; 18% advanced fibrosis; 47% MASLD). HBV with/without MASLD were similar in age, sex, and noncardiometabolic comorbidities (all p > 0.05) but those with MASLD had more advanced fibrosis (p < 0.01) and significantly lower PRO scores: FACIT-F Physical Well-Being and Fatigue domains and all CLDQ (all p < 0.01) especially Fatigue domain (6% reduction in score range). HCV patients with MASLD were younger, more frequently female (p < 0.01) with similar rates of advanced fibrosis, biopsy-proven cirrhosis, and noncardiometabolic comorbidities (all p > 0.05). They had significantly lower scores in FACIT-F Physical Well-Being and all CLDQ domains (all p < 0.01); the greatest impairment was in Systemic Symptoms and Worry domains (6% reduction in score range). MASLD was independently associated with lower CLDQ scores in multivariate analysis (p < 0.05). CONCLUSIONS: Approximately half of HBV or HCV patients had MASLD and reported significantly worse PROs, highlighting the importance of proactive metabolic assessment and management in patients with chronic viral hepatitis.