Martyn EmilyMullender ClaireOgunnaike StephenKemper AgneiszkaGhosh IndrajitPeppa DimitraTsochatzis EmmanouilGilson RichardFlanagan StuartCopas AndrewMacDonald DouglasArenas-Pinto AlejandroMatthews Philippa C2026-06-2010.64898/2026.06.15.26355674https://pubs.cidrz.org/handle/123456789/12975<jats:p>Introduction: The overlap between chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health challenge. We investigated the impact of MASLD and metabolic comorbidity in a diverse London viral hepatitis clinic. Methods: This retrospective cross-sectional study (May 2018-Feb 2024) included adults with CHB having controlled attenuation parameter (CAP) measurements. MASLD was defined as CAP &gt;264 dB/m plus ≥1 cardiometabolic factor (CMF). We used univariable and multivariable models to examine MASLD's relationship with liver stiffness and hepatitis B viral load (HBV VL). Results: Among 323 individuals (67% male, median age 36), most were from Black (35%) or non-white British/Irish (29%) backgrounds. Overall, 64% had ≥1 CMF, and 20% had MASLD. The CHB/MASLD group was significantly older (median 43 vs 35 years, p&lt;0.001) with higher median alanine transaminase (35 vs 30 IU/L, p=0.02) and liver stiffness (5.3 vs 4.7 kPa, p&lt;0.001). Following adjustment for covariates, MASLD remained significantly associated with liver stiffness (β = 0.48 kPa, p=0.03). While univariable analysis showed significantly lower HBV VL in people with MASLD (median 54 vs 417 IU/ml, p=0.004), adjusted multivariable analysis revealed no significant association between MASLD and log10 HBV VL (p=0.2). Conclusions: Although adjusted analysis does not support an independent association between MASLD and HBV VL, the data highlight a substantial cardiometabolic burden in this CHB population and clearly link MASLD to more severe liver disease. Holistic consideration of metabolic comorbidities is crucial in comprehensive CHB management.</jats:p>https://doi.org/10.64898/2026.06.15.26355674