Impact of prior HBV, HAV, and HEV infection on non-alcoholic fatty liver disease

Stephanos Vassilopoulos, Markos Kalligeros, Athanasios Vassilopoulos, Fadi Shehadeh, Gregorio Benitez, Matthew Kaczynski, Ingrid Lazaridou, Kittichai Promrat, Jack R. Wands, Eleftherios Mylonakis

Research output: Contribution to journalArticlepeer-review


Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. The association between prior hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis E virus (HEV) infection and NAFLD remains unclear. We utilized the 2017–2020 National Health and Nutrition Examination Survey (NHANES) and performed multivariable logistic regression analyses to examine the association of prior HBV, HAV and HEV infection with NAFLD, as well as high risk non-alcoholic steatohepatitis (NASH) and liver fibrosis. Our analysis included 2565 participants with available anti-HBc serology results, 1480 unvaccinated participants with anti-HAV results, and 2561 participants with anti-HEV results. Among participants with NAFLD, the age-adjusted prevalence of prior HBV, HAV and HEV infection was 3.48%, 32.08% and 7.45%, respectively. Prior infection with HBV, HAV and HEV was not associated with NAFLD (cut-off 285 dB/m) [aOR: 0.99 (95% CI, 0.77–1.29), 1.29 (95% CI, 0.95–1.75), and 0.94 (95% CI, 0.70–1.27), respectively] or high-risk NASH [aOR 0.72 (95% CI, 0.45–1.17), 0.92 (95% CI, 0.55–1.52), and 0.89 (95% CI, 0.41–1.94), respectively]. Participants with anti-HBc and anti-HAV seropositivity were more likely to have significant fibrosis [aOR: 1.53 (95% CI, 1.05–2.23) and 1.69 (95% CI, 1.16–2.47), respectively]. The odds of significant fibrosis are 53%, and 69% greater for participants with prior history of HBV and HAV infection. Healthcare providers should prioritize vaccination efforts and employ a tailored approach to NAFLD in patients with prior viral hepatitis and especially HBV or HAV infection to limit disease-related outcomes.

Original languageEnglish (US)
Pages (from-to)685-693
Number of pages9
JournalJournal of Viral Hepatitis
Issue number8
StatePublished - Aug 2023


  • HAV
  • HBV
  • HEV
  • liver fibrosis
  • Hepatitis E/epidemiology
  • Hepatitis A virus
  • Nutrition Surveys
  • Humans
  • Risk Factors
  • Hepatitis A Antibodies
  • Liver Cirrhosis
  • Hepatitis E virus
  • Hepatitis A/complications
  • Hepatitis B Antibodies
  • Hepatitis B virus
  • Non-alcoholic Fatty Liver Disease/complications

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology
  • Hepatology


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