Background: Hepatic steatosis, as a predictive factor in treatment outcome, was not investigated in chronic hepatitis B (CHB). The aim of this retrospective analysis is to determine possible relationships between hepatic steatosis and treatment response in patients with CHB. Methods: One hundred forty patients with CHB [42 hepatitis B e antigen (HBeAg)-positive, 98 HBeAg-negative] were analyzed. Seventy-eight patients (55.7%) received pegylated interferon a 2a 180 mu g/wk subcutaneously and 62 patients (44.3%) received pegylated interferon alpha 2a 180 mu g/wk plus lamivudine 100 mg/d combination therapy. Results: The presence of steatosis was associated with increased body mass index and hyperlipidemia. The sustained virologic response (SVR) rates in HBeAg-negative patients were 36.2% and 31.5% in patients with and without steatosis, respectively (P > 0.05). The SVR rates in HBeAg-positive patients were 39.6% and 33.3% in patients with and without steatosis, respectively (P > 0.05). The prevalence of hepatic steatosis did not significantly affect the outcome of treatments in both groups. In pegylated interferon monotherapy group (group 1), SVR was 18/78 (23%) and in the pegylated interferon plus lamivudine combination group (group 2) SVR was 16/62 (26%), (P > 0.05, NS). The independent factors affecting the treatment outcome were higher baseline alanine aminotransferase level and lower baseline viral load. Conclusions: The prevalence of steatosis is a common finding in CHB infection; however, it is not associated with viral load and treatment outcome.