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Metabolic dysfunction associated steatotic liver disease (MASLD) represents a significant and increasing burden of liver disease worldwide. The increasing prevalence of MASLD makes it a common secondary liver disease in people with chronic hepatitis B virus (HBV) infection. This study aimed to assess the prevalence of MASLD in a cohort of HBV patients attending a specialist viral hepatitis clinic and to audit the management of MASLD in this group.We reviewed electronic patient records of individuals with HBV who attended the Oxford viral liver clinic between October and December 2024. Data collected included demographics, medical history, lifestyle factors, clinical notes, imaging, and blood test results. Liver steatosis was identified via ultrasound, MRI, biopsy, or FibroScan CAP scores >280 dB/m. MASLD was defined as hepatic steatosis with at least one cardiometabolic risk factor and no harmful alcohol intake. Management practices were audited against BASL/BSG NAFLD special interest group quality standards. Descriptive statistics were used to analyse the data.Of 211 HBV patients seen during the study period, 61 (29%) had hepatic steatosis. Of these, 52 (85%) met MASLD criteria. Most had 2–3 metabolic risk factors (54%). All patients underwent annual fibrosis assessment with FibroScan. Alcohol intake was recorded in 69%, smoking status in 56%, and BMI in 62%. However, only 10% were screened for hypertension at every visit, and 13% had a QRISK3 score calculated. While 54% received weight loss advice, only 13% were given specific goals or strategies, and 13% were directed to relevant health resources. No patients received written MASLD information.The steatosis prevalence observed (29%) aligns with larger studies (29.6%–34.9%). Our audit suggests that management of patients with MASLD and HBV may be outside recommended national standards. It is possible that some quality standards were previously addressed but not captured during the study period. Nonetheless, we have identified some areas where practice could improve. There is no standardised screening method for metabolic syndrome in those with steatosis even though these represent nearly 1/3 of all people with chronic HBV seen in clinic. Furthermore, we do not routinely provide written information or signpost to sources relevant to MASLD, or to how to achieve the recommended targets. To address these gaps, we have introduced a standardised clinic letter template to improve documentation and support adherence to quality standards. A follow-up audit is planned in one year to evaluate the impact of this intervention.Abstract P8 Figure 1References Rinella Mary E, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology 2023;79;(6):1542–1556.McPherson S, Armstrong MJ, Cobbold JF, Corless L, Anstee QM, Aspinall RJ, Barclay ST, Brennan PN, Cacciottolo TM, Goldin RD, Hallsworth K, Hebditch V, Jack K, Jarvis H, Johnson J, Li W, Mansour D, McCallum M, Mukhopadhya A, Parker R, Ross V, Rowe IA, Srivastava A, Thiagarajan P, Thompson AI, Tomlinson J, Tsochatzis EA, Yeoman A, Alazawi W. Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the british association for the study of the liver and british society of gastroenterology NAFLD special interest group. Lancet Gastroenterol Hepatol. 2022 Aug;7(8):755–769. doi: 10.1016/S2468–1253(22)00061–9. Epub 2022 Apr 28. PMID: 35490698; PMCID: PMC7614852.Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients. J Gastroenterol Hepatol. 2011;26:1361–7.Jiang D, Chen C, Liu X, Huang C, Yan D, Zhang X, et al. Concurrence and impact of hepatic steatosis on chronic hepatitis B patients: a systematic review and meta-analysis. Ann Transl Med. 2021;9:1718. doi: 10.21037/atm-21–3052.