Fittipaldi Juliana, Cardoso Sandra W, Nunes Estevão Portela, De Almeida Cristiane Fonseca, De Brito Patricia Dias, Veloso Valdilea G, Grinsztejn Beatriz, Perazzo Hugo
Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
AIDS. 2025 Jun 5. doi: 10.1097/QAD.0000000000004250.
To describe the association of metabolic dysfunction-associated steatotic liver disease (MASLD) with clinically significant liver fibrosis (CSLF) in people with HIV from Rio de Janeiro (Brazil).
Cross-sectional study.
We analyzed data from the baseline visit of the PROSPEC-HIV-study (NCT02542020). People living with HIV aged ≥ 18 years were submitted to clinical evaluation, questionnaires, blood sample and transient elastography (TE) at INI/FIOCRUZ from June/2015 to March/2019. Exclusion criteria were unreliable TE or missing data. Steatosis and liver fibrosis were assessed by Controlled Attenuation Parameter (CAP) and liver stiffness measurement (LSM) from TE, respectively. MASLD was determined by presence of steatosis (TE-CAP ≥ 263 dB/m) with at least one cardiometabolic-risk-factor (overweight/obesity, diabetes, hypertension or dyslipidemia) without hazard alcohol intake. CSLF was defined by TE-LSM ≥ 8.0 kPa. Multivariate logistic regression models were performed.
684 participants [47.8% male, median age= 45 (IQR,36-53) years, 12% with diabetes and 13% with viral hepatitis coinfection] were included. The prevalence [95%CI] of MASLD and CSLF were 19.3% [16.5-22.4] and 14.2% [11.8-17.0], respectively. In the multivariate analysis [OR (95%CI)], older age [1.52 (1.75-1.96)], MASLD [2.20 (1.25-3.87)], viral hepatitis [4.93 (2.72-8.94)], higher ALT levels [1.11 (1.04-1.18)] and CD4 count < 350 cells/mm3 [1.95 (1.07-3.53)] were significantly associated with presence of CSLF. MASLD remained independently associated with CSLF in people with HIV mono-infection (n = 595) [OR = 2.18 (95%CI,1.19-3.98)].
MASLD increased the odds of CSLF in people with HIV independently of viral hepatitis. Strategies to screen MASLD in are of paramount importance to reduce the burden of liver disease in people with HIV.
描述巴西里约热内卢HIV感染者中代谢功能障碍相关脂肪性肝病（MASLD）与临床显著肝纤维化（CSLF）之间的关联。
横断面研究。
我们分析了PROSPEC-HIV研究（NCT02542020）基线访视的数据。2015年6月至2019年3月期间，年龄≥18岁的HIV感染者在INI/FIOCRUZ接受了临床评估、问卷调查、血液样本采集和瞬时弹性成像（TE）检查。排除标准为TE不可靠或数据缺失。分别通过TE的受控衰减参数（CAP）和肝脏硬度测量（LSM）评估脂肪变性和肝纤维化。MASLD的判定标准为存在脂肪变性（TE-CAP≥263dB/m）且至少有一种心血管代谢危险因素（超重/肥胖、糖尿病、高血压或血脂异常），且无有害酒精摄入。CSLF的定义为TE-LSM≥8.0kPa。进行多变量逻辑回归模型分析。
纳入684名参与者[男性占47.8%，中位年龄 = 45（四分位间距，36 - 53）岁，12%患有糖尿病，13%合并病毒肝炎感染]。MASLD和CSLF的患病率[95%置信区间]分别为19.3%[16.5 - 22.4]和14.2%[11.8 - 17.0]。在多变量分析中[比值比（95%置信区间）]，年龄较大[1.52（1.75 - 1.96）]、MASLD[2.20（1.25 - 3.87）]、病毒肝炎[
