What is the impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on outcomes in people living with chronic hepatitis B (CHB)? An umbrella review protocol.

Abstract

Introduction: An estimated 254 million people are living with chronic hepatitis B virus (CHB) and 1.6 billion with metabolic dysfunction-associated steatotic liver disease (MASLD) worldwide. CHB remains a major global health challenge, despite a robust vaccine and suppressive antiviral treatment, and MASLD prevalence is increasing in line with a rise in cardiometabolic risk factors, such as obesity and type 2 diabetes. Thus, understanding the impact of concurrent CHB and MASLD on liver health is important to inform clinical practice and population surveillance. Current literature, including over ten systematic reviews and meta-analyses, yields conflicting evidence about the interplay between CHB and MASLD. This protocol describes a study aiming to critically appraise published systematic reviews investigating the effect of MASLD on liver outcomes in people living with CHB, identify gaps in the available data and assist scientists and clinicians in informing future research design.

Methods and analysis: We will use umbrella review methodology from the Joanna Briggs Institute (JBI) to evaluate and synthesise evidence from existing systematic reviews and meta-analysis investigating liver and viral outcomes (fibrosis, cirrhosis, hepatocellular carcinoma, response to antiviral treatment, and impact on CHB biomarkers e.g. hepatitis B surface antigen, hepatitis B e-antigen and viral load) in CHB and MASLD, compared to CHB alone. We will search Ovid Medline, Ovid Embase, PubMed and Web of Science. We will assess methodological quality using the Assessing the Quality of Systematic Reviews-2 (AMSTAR-2) tool, compare study characteristics and present important results.

Ethics and dissemination: No ethics approval is required as we will use only data from systematic reviews that are already published. Results will be included in a PhD thesis, submitted for consideration for presentation at international conferences and for peer review for publication in a scientific journal. We will endeavour to share results with relevant public and patient organisations. Registration details This umbrella review has been published on PROSPERO (ID CRD420261308282).