The Importance and Impact of Recognizing MAFLD in Patients With Chronic Hepatitis C

Abstract

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 due to a single factor. 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 who had a liver biopsy with scoring for fibrosis stage and disease activity. 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). Although the MAFLD only group had worse metabolic markers, patients with significant fibrosis (F3-F4) were more common in those with dual disease (CHC/MAFLD; 33%) compared to MAFLD alone (29%). Interestingly, lean patients with CHC and MAFLD had similar fibrosis stage compared to the two other subgroups of MAFLD (obesity and/or Diabetes Mellitus). Conclusion: Patients with chronic hepatitis C 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. Funding Statement: No additional funding. Declaration of Interests: No conflicts of interest for all authors mentioned. Ethics Approval Statement: Ethics approvals were obtained from the Human Research Ethics Committee of the Sydney West Area Health Service and Nepean Blue Mountains Local Health District, Human Research Ethics Committees. Written informed consent was obtained from all patients.