Concurrent HCV or fatty liver in patients with chronic hepatitis B virus infection

In hepatitis B virus (HBV) endemic countries, we may encounter subjects with concurrent hepatitis C virus (HCV) infection or fatty liver. Concurrent HCV infection or fatty liver has been demonstrated to accelerate the progression of HBV-related liver diseases. For the former, because of similar modes of transmission and related risk factors, we may encounter patients with HBV/HCV coinfection among populations who are at risk of parenteral hepatitis viral transmission. Furthermore, in HBV-endemic countries, HBV/HCV coinfection can be found due to HCV superinfection on preexisting hepatitis B surface antigen carriage. Major achievements in the management of patients with HCV/HBV coinfection have been accomplished in the past 2 decades. For the latter, nonalcoholic fatty liver disease (NAFLD) has become another common liver disorder in adult and even adolescent populations. The number of patients with concurrent chronic hepatitis B and NAFLD is increasing. However, the associations of HBV infection with metabolic derangement, insulin resistance, and the risk of cardiovascular diseases are still not completely clarified. Briefly, the presence of metabolic syndrome is associated with the progression of liver disease in patients with chronic HBV infection. Thus apart from the control of hepatitis B activity, metabolic derangement should be corrected. In this chapter, the epidemiology, clinical impact, and management of concurrent hepatitis C virus infection or fatty liver will be summarized.