Chronic Viral Hepatitis B and C Outweigh MASLD in the Associated Risk of Cirrhosis and HCC

Background & Aims: The impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on the development of cirrhosis and hepatocellular carcinoma (HCC) by chronic hepatitis B (CHB) or C infection and antiviral treatment statuses is not well-known. Methods: A total of 336,866 adults aged ≥30 years were prospectively enrolled in a health screening program between 1997–2013. MASLD was identified by abdominal ultrasonography and cardiometabolic profiles. Data linkage was performed using 3 nationwide databases—National Health Insurance, Cancer Registry, and Death Certification System—to obtain information on antiviral treatment, vital status, and newly diagnosed cirrhosis and HCC. Follow-up was conducted until December 31, 2019. Results: In the total population, 122,669 (36.4%) had MASLD. Over a mean follow-up of 15 years, 5562 new cases of cirrhosis and 2273 new cases of HCC were diagnosed. Although MASLD significantly increased the cumulative risks of cirrhosis or HCC (P < .0001), the associated risk was more pronounced when comparing CHB or C infection with the presence of MASLD. Stratifying the participants based on their MASLD and CHB or C statuses, hazard ratios (HR_adj) with 95% confidence intervals for HCC were 8.81 (7.83–9.92) for non-steatotic liver disease (SLD) with CHB or C, 1.52 (1.32–1.74) for MASLD without CHB or C, and 8.86 (7.76–10.12) for MASLD with CHB or C, compared with non-SLD without CHB or C (all P < .0001). Among CHB or C patients who received antivirals during follow-up, MASLD was associated with increased risks of cirrhosis and HCC, with HR_adj of 1.23 (1.01–1.49) and 1.32 (1.05–1.65), respectively. Conclusions: These findings underscore the need to prioritize treatment of chronic viral hepatitis before addressing MASLD.