Entecavir provides favorable virological control but minimal metabolic benefit in patients with Chronic Hepatitis B and MAFLD.

OBJECTIVE: To systematically evaluate the multidimensional efficacy of entecavir in patients with Chronic Hepatitis B (CHB) complicated with metabolic-associated fatty liver disease (MAFLD), with a focus on virological response, liver function, and metabolic parameters. METHODS: A retrospective analysis was conducted on 285 patients with CHB and concurrent MAFLD who received entecavir treatment at Minzu Hospital of Guangxi Zhuang Autonomous Region between January 2022 and May 2024 (MAFLD with comorbidities group). During the same period, 310 CHB patients without MAFLD served as the viral-only group. Both groups were treated with entecavir. Baseline characteristics, treatment efficacy at week 35, virological response, liver function parameters, fibrosis progression, metabolic indicators, and safety profiles were compared between the two groups. RESULTS: Compared with the viral-only group, patients in the MAFLD with comorbidities group exhibited significantly higher body mass index (BMI), waist circumference (WC), homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin (FINS), and triglyceride (TG) levels, as well as lower high-density lipoprotein cholesterol (HDL-C) levels, alanine aminotransferase (ALT)/aspartate aminotransferase (AST) normalization rates, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) negativity rates, and hepatitis B e-antigen (HBeAg) seroconversion rates (P < 0.05). AST and GGT levels were also significantly lower in the viral-only group than in the MAFLD with comorbidities group (P < 0.05). Post-treatment fibrosis staging was more advanced in the MAFLD with comorbidities group (P < 0.05). After treatment, patients with MAFLD maintained higher HOMA-IR and TG levels and lower HDL-C levels than those without MAFLD (P < 0.05). During follow-up, the overall incidence of adverse events was 2.11% in the MAFLD with comorbidities group and 1.94% in the viral-only group, with no statistically significant difference between the groups (P > 0.05). CONCLUSION: Entecavir can effectively control viral replication in patients with CHB combined with MAFLD. However, the recovery of liver function, improvement of steatosis and improvement of metabolic indicators were all slightly inferior to those of the non-MAFLD population, suggesting that the coexistence of MAFLD may weaken the comprehensive benefits of antiviral treatment.