HBV increases cirrhosis risk in patients with NAFLD and T2DM

Takeaway

• In type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD), hepatitis B virus (HBV) infection increased the risk for cirrhosis and hepatocellular carcinoma (HCC) compared with patients with T2DM only.
• The risk associated with HBV infection was similar to the risk among patients without diabetes.

Why this matters

• This approach to evaluating the role of T2DM/NAFLD and HBV infection in liver disease progression could be applied to other settings with higher HBV prevalence.
• Prevention of both HBV and T2DM could help lower the burden of cirrhosis and HCC.

Study design

• Study of 265,792 patients (aged ≥18 years) using data from the UK Clinical Practice Research Datalink (CPRD) with three cohorts:
  • T2DM with HBV infection (n=297; mean follow-up period: 8.7 years),
  • T2DM without HBV infection (n=261,865: mean follow-up period: 11.5 years) and
  • HBV infection without T2DM (n=3630: mean follow-up period: 6.2 years).
• Outcome: progression to cirrhosis and HCC.
• Funding: GlaxoSmithKline Biologicals S.A.

Key results

• The calculated incidence rates for cirrhosis were:
  • T2DM+HBV cohort: 29.06 (95% CI, 5.99-84.91) per 10,000 person-years,
  • T2DM cohort: 2.68 (95% CI, 2.41-2.96) per 10,000 person-years and
  • HBV cohort: 22.35 (95% CI, 15.19-31.72) per 10,000 person-years.
• T2DM+HBV cohort vs T2DM cohort showed a higher risk for progression to:
  • cirrhosis (adjusted IRR [aIRR],14.06; 95% CI: 4.47-44.19) and
  • HCC (aIRR, 2.83; 95% CI, 1.06-7.55).
• T2DM+HBV cohort vs HBV cohort showed no increased risk for cirrhosis (aIRR, 0.68; 95% CI, 0.21-2.27).
• Based on the estimated time-to event, the risk for progression to HCC was significantly higher in the T2DM+HBV cohort vs T2DM cohort (aHR, 2.85; 95% CI, 1.07-7.61) and similarly for T2DM+HBV cohort vs HBV cohorts (aHR, 1.40; 95% CI, 0.46-4.24).

Limitations

• Risk for classification bias.
• Small sizes of T2DM and HBV cohort.