Why Outcomes Diverge in Chronic Hepatitis B with Steatotic Liver Disease: Lessons from Within-Study Contrasts

Background and Objectives: The “friend or foe” debate in chronic hepatitis B (CHB) with steatotic liver disease (SLD) partly arises from treating hepatic fat, metabolic burden, and steatohepatitis as one exposure and interpreting different outcomes together. Materials and Methods: This narrative review applies an exposure–stage–context framework to literature identified in PubMed and Web of Science through 21 September 2026. We synthesized outcome evidence from 119 reports, including 14 detailed examples, using within-study comparisons of exposures, outcomes, and patient subgroups.