Influence of Besifovir Dipivoxil Maleate Combined with L-Carnitine on Hepatic Steatosis in Patients with Chronic Hepatitis B

Background: Besifovir dipivoxil maleate (BSV) with L-carnitine is the first-line antiviral agent for chronic hepatitis B (CHB) infection. We investigated whether BSV combined with L-carnitine improves hepatic steatosis (HS). Methods: Treatment-naive patients with CHB who were initiated on antiviral therapy (AVT) were enrolled. The magnitude of HS was assessed using hepatic steatosis index (HSI), and HS improvement was defined as a >= 10% reduction in the HSI score from the baseline. Results: The mean age of the study patients was 56 years with a male predominance (n = 178, 64.7%). The mean body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count were 23.5 kg/m(2), 49.6 IU/L, 49.0 IU/L, and 191.3 X 10(9)/L, respectively. The mean HSI and fibrosis (FIB)-4 index were 32.6 and 0.5, respectively. After 6 months of AVT, platelet count (mean, 191.3 -> 167.0 x 10(9)/L), fasting glucose (mean, 113.1 -> 105.9 mg/dL), AST (mean, 49.6 -> 28.0 IU/L), ALT (mean, 49.0 -> 33.9 IU/L), and total cholesterol (mean, 170.0 -> 162.1 mg/dL) levels significantly decreased (all P< 0.05). In the BSV group, AST (mean, 95.2 -> 30.2 IU/L) and ALT (mean, 81.1 -> 31.1 IU/L) levels significantly reduced (all P < 0.05), whereas HSI and FIB-4 index were maintained (all P> 0.05). In the univariate analysis, age, BMI, diabetes, cirrhosis, fasting glucose level, and ALT were significantly associated with HS improvement (all P< 0.05). Conclusion: BSV with L-carnitine did not show any improvement of HS in patients with CHB. Further prospective randomized controlled studies are needed to validate the potential beneficial effects of BSV with L-carnitine in CHB infection.