1 Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.
2 Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Palo Alto, CA, United States.
3 Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, United States.
We read with interest the recent paper by Choi et al(1) on the impact of biopsy-proven NASH on CHB outcomes. The study concluded that compared to patients with CHB alone, CHB patients with concomitant NASH were more likely to have advanced fibrosis (F3/4) and shorter time to liver complications, and that superimposed NASH predicted poorer outcomes in those with advanced fibrosis. However, prior studies have also suggested that CHB patients with co-existing hepatic steatosis may not be at higher risk for disease progression; and in fact, more favorable long-term outcomes were even reported by some.