MASLD Overlaps With Nearly Half of Chronic Viral Hepatitis Cases

Nearly half of patients with chronic HBV or HCV also had MASLD, tied to worse fatigue and quality of life. Roughly half of patients with chronic hepatitis B or C also have metabolic dysfunction-associated steatotic liver disease (MASLD), and those carrying both diagnoses reported significantly worse fatigue, systemic symptoms, and quality of life than patients with viral hepatitis alone, according to a cross-sectional analysis of the Global Liver Registry published in the Journal of Gastroenterology and Hepatology.

1 MASLD Adds to a Persistent Global Hepatitis Burden Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection remain among the world's most common liver diseases. An estimated 287 million people were living with chronic HBV or HCV infection in 2024, and the 2 viruses together caused roughly 1.3 million deaths that year, according to the World Health Organization's most recent global hepatitis report.

Fewer than 5% of the 240 million people living with chronic HBV were receiving treatment. 2 MASLD, driven by obesity, type 2 diabetes, and other cardiometabolic risk factors, has grown more common worldwide and increasingly coexists with viral hepatitis in the same patient. How that overlap affects day-to-day symptoms and quality of life, rather than liver histology alone, had not been systematically examined across a large, multinational cohort.

A Global Registry Compares MASLD in Chronic Hepatitis The researchers analyzed cross-sectional clinical and patient-reported outcome (PRO) data from the Global Liver Registry, an international database of patients with chronic liver disease. MASLD was defined as a Hepatic Steatosis Index of 36 or higher plus at least 1 cardiometabolic risk factor (overweight, type 2 diabetes, hypertension, or hyperlipidemia).

PROs were captured with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Chronic Liver Disease Questionnaire (CLDQ), and the Work Productivity and Activity Impairment questionnaire. The analysis included 4649 patients: 2063 with HBV (mean age, 48 years; 57% male; 11% with advanced fibrosis) and 2586 with HCV (mean age, 56 years; 47% male; 18% with advanced fibrosis).

MASLD was present in 49% of the HBV group and 47% of the HCV group, underscoring how common the metabolic-viral overlap had become in this population. MASLD Worsens Fibrosis and Fatigue in HBV Patients with HBV and MASLD were similar in age, sex, and nonmetabolic comorbidities to those with HBV alone (all P > .05), but they had significantly more advanced fibrosis ( P < .01).

They also scored significantly lower on the FACIT-F Physical Well-Being and Fatigue domains and on every CLDQ domain (all P < .01), with the largest gap in the Fatigue domain, a 6% reduction across the scale's full range. That pattern suggests MASLD adds a distinct symptom burden on top of HBV itself, rather than simply reflecting older or sicker patients accumulating a second diagnosis.

Because the Global Liver Registry enrolls patients across multiple countries, the consistency of this pattern across such a geographically diverse HBV population strengthens the case that the association is not a quirk of a single health system. In HCV, MASLD Skews Younger and More Often Female Among patients with HCV, those with MASLD were significantly younger and more frequently female than those without it (both P < .01), despite having similar rates of advanced fibrosis, biopsy-confirmed cirrhosis, and nonmetabolic comorbidities (all P > .05).

They scored significantly lower on the FACIT-F Physical Well-Being domain and all CLDQ domains (all P < .01), with the steepest declines in the Systemic Symptoms and Worry domains, each also a 6% reduction across the scale's range. In multivariate analysis adjusting for other clinical factors, MASLD remained independently associated with lower CLDQ scores ( P < .05).

This independent association held even after accounting for fibrosis stage and other clinical variables, reinforcing that the metabolic component carries its own distinct effect on how patients feel day to day, rather than acting only through fibrosis severity or age differences.

Metabolic Screening May Belong in Routine Hepatitis Care Because the analysis was cross-sectional, it cannot establish whether MASLD causes the added symptom burden or simply accompanies it. The researchers also relied on a validated noninvasive index rather than imaging or biopsy to define MASLD across thousands of patients, a practical tradeoff for a registry of this scale but one that leaves some misclassification possible.

For clinicians, the findings argue for screening patients with chronic viral hepatitis for cardiometabolic risk factors rather than assuming stable fibrosis status means a stable symptom burden. For payers and health systems, with nearly half of this viral hepatitis population also carrying a metabolic liver diagnosis, the data suggest that managing weight, diabetes, and lipids alongside antiviral therapy could meaningfully affect patient-reported quality of life, not just long-term liver outcomes.

References Papatheodoridis G, Buti M, Yilmaz Y, et al. Chronic viral hepatitis with MASLD: implications for clinical and patient-reported outcomes. J Gastroenterol Hepatol .

2026;41(8):2440-2447. doi:10.1111/jgh.70533 World Health Organization. Global hepatitis report 2026: actions for access to prevent, test and treat. Published April 28, 2026.

Accessed October 28, 2026. https://www.who.int/publications/i/item/9789240122383 Related to this article