Editorial: chronic hepatitis C with metabolic dysfunction‐associated fatty liver disease — a model for adoption of Sustainable Development Goal 3

Chronic hepatitis C (CHC) and fatty liver are communicable and noncommunicable diseases, respectively, that risk progression to cirrhosis and liver decompensation. Hepatitis C virus (HCV) genotype 3 has been associated with hepatic steatosis and a potential reduction in steatosis severity following viral eradication.1 CHC, hepatic steatosis and excessive alcohol consumption can coexist and may have individual or synergistic effects on the progression of chronic liver disease and liverrelated outcomes. Although the incidence of CHC is reducing globally, due largely to highly effective directacting antiviral drugs,2 a global increase in nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunctionassociated fatty liver disease (MAFLD) are expected as the incidence of obesity, metabolic syndrome and type 2 diabetes increase. Approximately 30.9% of the world's population is believed to have NAFLD.3 A metaanalysis similarly estimates a 38.8% global prevalence of MAFLD.4 Many individuals with eradicated or active CHC also have a fatty liver that may impact outcomes of antiviral drug therapy or result in persisting or progressive liver disease.5 Individuals with MAFLD with CHC (MAFLDC) are considered to have an increased risk of adverse liverrelated outcomes, compared with those with CHC alone.6,7 With the heterogeneity of the MAFLD phenotype, there is a paucity of data regarding the burden of MAFLDC, and the associated risk of future cirrhosis, decompensation and hepatocellular carcinoma after the sustained virological response has been achieved with interferonbased or directacting antiviral (DAA) drug therapy. Although HCV eradication using DAAs reduces the risk of hepatocellular carcinoma,8 current HCV management guidelines rarely highlight a need for metabolic risk factor management in individuals with CHC. In fact, nonalcoholic steatohepatitis (NASH) clinical trials generally exclude people with current or previous CHC. In their recent study, Attia et al examined the changing prevalence of MAFLD in a predominantly obese cohort of 288,222 adults with CHC in Egypt between 2007 and 2020.9 The 19% prevalence of MAFLD during the 2007– 2013 assessment provides a minimum