{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:37:22Z","timestamp":1792103842539,"version":"4.4.0"},"posted":{"date-parts":[[2026,6,17]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":37,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"award":["CC2223"],"award-info":[{"award-number":["CC2223"]}],"id":[{"id":"https:\/\/ror.org\/04tnbqb63","id-type":"ROR","asserted-by":"publisher"}]},{"name":"University College London NIHR Biomedical Research Centre"},{"DOI":"10.13039\/100015326","name":"NIH Common Fund","doi-asserted-by":"crossref","award":["R01AI55182"],"award-info":[{"award-number":["R01AI55182"]}],"id":[{"id":"10.13039\/100015326","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The overlap between chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health challenge. We investigated the impact of MASLD and metabolic comorbidity in a diverse London viral hepatitis clinic.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective cross-sectional study (May 2018\u2013Feb 2024) included adults with CHB having controlled attenuation parameter (CAP) measurements. MASLD was defined as CAP &gt;264 dB\/m plus \u22651 cardiometabolic factor (CMF). We used univariable and multivariable models to examine MASLD\u2019s relationship with liver stiffness and hepatitis B viral load (HBV VL).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 323 individuals (67% male, median age 36), most were from Black (35%) or non-white British\/Irish (29%) backgrounds. Overall, 64% had \u22651 CMF, and 20% had MASLD. The CHB\/MASLD group was significantly older (median 43 vs 35 years, p&lt;0.001) with higher median alanine transaminase (35 vs 30 IU\/L, p=0.02) and liver stiffness (5.3 vs 4.7 kPa, p&lt;0.001). Following adjustment for covariates, MASLD remained significantly associated with liver stiffness (\u03b2 = 0.48 kPa, p=0.03). While univariable analysis showed significantly lower HBV VL in people with MASLD (median 54 vs 417 IU\/ml, p=0.004), adjusted multivariable analysis revealed no significant association between MASLD and log10 HBV VL (p=0.2).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although adjusted analysis does not support an independent association between MASLD and HBV VL, the data highlight a substantial cardiometabolic burden in this CHB population and clearly link MASLD to more severe liver disease. Holistic consideration of metabolic comorbidities is crucial in comprehensive CHB management<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.15.26355674","type":"posted-content","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T01:10:37Z","timestamp":1781745037000},"source":"Crossref","is-referenced-by-count":1,"title":["The interaction between chronic hepatitis B (CHB) and Metabolic dysfunction-associated steatotic liver disease (MASLD) in a diverse central London population"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-9298","authenticated-orcid":false,"given":"Emily","family":"Martyn","sequence":"first","affiliation":[{"name":"Francis Crick Institute, London, London, UK"},{"name":"Division of Infection, Immunity and Transplantation, University College London, London, UK"},{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Mullender","sequence":"additional","affiliation":[{"name":"Infection Care Group, St George\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Ogunnaike","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Kemper","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5311-9885","authenticated-orcid":false,"given":"Indrajit","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"},{"name":"Division of Infection, University College London Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9281-5471","authenticated-orcid":false,"given":"Dimitra","family":"Peppa","sequence":"additional","affiliation":[{"name":"Division of Infection, Immunity and Transplantation, University College London, London, UK"},{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanoulis","family":"Tsochatzis","sequence":"additional","affiliation":[{"name":"Sheila Sherlock Liver Centre, Royal Free Hospital NHS Foundation Trust, London, UK"},{"name":"UCL Institute for Liver and Digestive Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9572-193X","authenticated-orcid":false,"given":"Richard","family":"Gilson","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"},{"name":"Centre for Clinical Research in Infection and Sexual Health, University College London, Capper Street, London, WC1E 6JB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"},{"name":"Division of Infection, University College London Hospital NHS Foundation Trust, London, UK"},{"name":"Centre for Clinical Research in Infection and Sexual Health, University College London, Capper Street, London, WC1E 6JB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-5963","authenticated-orcid":false,"given":"Andrew","family":"Copas","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research in Infection and Sexual Health, University College London, Capper Street, London, WC1E 6JB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Sheila Sherlock Liver Centre, Royal Free Hospital NHS Foundation Trust, London, UK"},{"name":"UCL Institute for Liver and Digestive Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3368-5005","authenticated-orcid":false,"given":"Alejandro","family":"Arenas-Pinto","sequence":"additional","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"},{"name":"Centre for Clinical Research in Infection and Sexual Health, University College London, Capper Street, London, WC1E 6JB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-4269","authenticated-orcid":false,"given":"Philippa C","family":"Matthews","sequence":"additional","affiliation":[{"name":"Francis Crick Institute, London, London, UK"},{"name":"Division of Infection, Immunity and Transplantation, University College London, London, UK"},{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"},{"name":"Division of Infection, University College London Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"issue":"1","key":"2026062003350580000_2026.06.15.26355674v1.1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","article-title":"Hepatocellular carcinoma","volume":"7","year":"2021","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"2026062003350580000_2026.06.15.26355674v1.2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12876-025-04497-4","article-title":"Global, regional, and national burden of NAFLD in adults aged 20-49 years (1990-2021): a comprehensive analysis of trends, decomposition, and health inequality","volume":"26","year":"2025","journal-title":"BMC Gastroenterol"},{"key":"2026062003350580000_2026.06.15.26355674v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2024.02.007"},{"key":"2026062003350580000_2026.06.15.26355674v1.4","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000000004"},{"issue":"9","key":"2026062003350580000_2026.06.15.26355674v1.5","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S2468-1253(22)00124-8","article-title":"Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"7","author":"GBD 2019 Hepatitis B Collaborators","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026062003350580000_2026.06.15.26355674v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2023.101133"},{"key":"2026062003350580000_2026.06.15.26355674v1.7","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32792"},{"issue":"10","key":"2026062003350580000_2026.06.15.26355674v1.8","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/jvh.13872","article-title":"Clinical impact of hepatic steatosis on chronic hepatitis B patients in Asia: A systematic review and meta-analysis","volume":"30","year":"2023","journal-title":"J Viral Hepat"},{"key":"2026062003350580000_2026.06.15.26355674v1.9","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2023.0004"},{"issue":"9","key":"2026062003350580000_2026.06.15.26355674v1.10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/s41575-025-01101-8","article-title":"Viral hepatitis: breaking down barriers","volume":"22","year":"2025","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2026062003350580000_2026.06.15.26355674v1.11","unstructured":"Website. https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/blogs\/glp-1-drugs-nhs-should-roll-them-out-at-scale"},{"key":"2026062003350580000_2026.06.15.26355674v1.12","doi-asserted-by":"publisher","DOI":"10.6084\/M9.FIGSHARE.C.7114783.V6"},{"key":"2026062003350580000_2026.06.15.26355674v1.13","doi-asserted-by":"publisher","DOI":"10.6084\/M9.FIGSHARE.25338307"},{"issue":"4","key":"2026062003350580000_2026.06.15.26355674v1.14","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/S2352-3018(20)30036-9","article-title":"HIV and cardiovascular disease","volume":"7","year":"2020","journal-title":"Lancet HIV"},{"key":"2026062003350580000_2026.06.15.26355674v1.15","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12035"},{"key":"2026062003350580000_2026.06.15.26355674v1.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.23242"},{"issue":"3","key":"2026062003350580000_2026.06.15.26355674v1.17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S2468-1253(20)30357-5","article-title":"Assessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis","volume":"6","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026062003350580000_2026.06.15.26355674v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2007.08.005"},{"key":"2026062003350580000_2026.06.15.26355674v1.19","unstructured":"Guidelines for the Prevention, Diagnosis, Care and Treatment for People with Chronic Hepatitis B Infection. World Health Organization; 2024."},{"issue":"10481","key":"2026062003350580000_2026.06.15.26355674v1.20","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0140-6736(25)00260-0","article-title":"Forecasting the global obesity epidemic through 2050","volume":"405","year":"2025","journal-title":"Lancet"},{"issue":"23","key":"2026062003350580000_2026.06.15.26355674v1.21","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.21037\/atm-21-3052","article-title":"Concurrence and impact of hepatic steatosis on chronic hepatitis B patients: a systematic review and meta-analysis","volume":"9","year":"2021","journal-title":"Ann Transl Med"},{"issue":"3","key":"2026062003350580000_2026.06.15.26355674v1.22","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/liv.14369","article-title":"Chronic hepatitis B and non-alcoholic fatty liver disease: Conspirators or competitors?","volume":"40","year":"2020","journal-title":"Liver Int"},{"issue":"3","key":"2026062003350580000_2026.06.15.26355674v1.23","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s12072-024-10639-9","article-title":"Impact of chronic hepatitis B and concurrent steatosis on the risk of hepatocellular carcinoma","volume":"18","year":"2024","journal-title":"Hepatol Int"},{"key":"2026062003350580000_2026.06.15.26355674v1.24","doi-asserted-by":"crossref","unstructured":"Sattar N , Forrest E , Preiss D . Non-alcoholic fatty liver disease. BMJ. 2014;349:g4596.","DOI":"10.1136\/bmj.g4596"},{"issue":"3","key":"2026062003350580000_2026.06.15.26355674v1.25","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.cgh.2023.09.040","article-title":"Metabolic Dysfunction-Associated Steatotic Liver Disease Facilitates Hepatitis B Surface Antigen Seroclearance and Seroconversion","volume":"22","year":"2024","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026062003350580000_2026.06.15.26355674v1.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.12.006"},{"key":"2026062003350580000_2026.06.15.26355674v1.27","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.04.048"},{"issue":"9","key":"2026062003350580000_2026.06.15.26355674v1.28","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1111\/apt.16595","article-title":"Systematic review with meta-analysis: prevalence of hepatic steatosis, fibrosis and associated factors in chronic hepatitis B","volume":"54","year":"2021","journal-title":"Aliment Pharmacol Ther"},{"issue":"3","key":"2026062003350580000_2026.06.15.26355674v1.29","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/MRM.0000000000000303","article-title":"Metabolic syndromes, hepatitis B virus (HBV), and hepatitis C virus as three factors involved in the development of hepatic steatosis: a systematic review and meta-analysis","volume":"33","year":"2022","journal-title":"Reviews and Research in Medical Microbiology"},{"key":"2026062003350580000_2026.06.15.26355674v1.30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2011.06801.x"},{"issue":"4","key":"2026062003350580000_2026.06.15.26355674v1.31","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S2468-1253(23)00315-1","article-title":"Under-representation of the WHO African region in clinical trials of interventions against hepatitis B virus infection","volume":"9","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026062003350580000_2026.06.15.26355674v1.32","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.81070"},{"key":"2026062003350580000_2026.06.15.26355674v1.33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.4063"},{"key":"2026062003350580000_2026.06.15.26355674v1.34","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50346"},{"issue":"4","key":"2026062003350580000_2026.06.15.26355674v1.35","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1159\/000539371","article-title":"European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)","volume":"17","author":"European Association for the Study of the Liver (EASL)","year":"2024","journal-title":"Obes Facts"},{"key":"2026062003350580000_2026.06.15.26355674v1.36","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"2026062003350580000_2026.06.15.26355674v1.37","unstructured":"List of ethnic groups. Accessed March 25, 2026. https:\/\/www.ethnicity-facts-figures.service.gov.uk\/style-guide\/ethnic-groups\/"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.06.15.26355674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T10:35:17Z","timestamp":1781951717000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.06.15.26355674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":37,"URL":"https:\/\/doi.org\/10.64898\/2026.06.15.26355674","relation":{},"subject":[],"published":{"date-parts":[[2026,6,17]]},"subtype":"preprint"}}