BACKGROUND

We aimed to investigate the prevalence of liver fibrosis and identify the associated risk factors among people with HIV (PWH) and metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

Abdominal ultrasonography and transient elastography were performed to assess liver fibrosis and steatosis. Lean MASLD was defined as MASLD occurring in PWH with a body mass index (BMI) < 24 kg/m. A cutoff of liver stiffness measurement ≥ 7.1 kPa was set for significant liver fibrosis. The prevalence, correlation factors, and risk factors were evaluated.

RESULTS

Among 361 PWH, 250 (69.25%) had a BMI < 24 kg/m, and 141 (39.06%) were diagnosed with MASLD. The 141 PWH with MASLD were classified as 2 groups based on BMI: 58 (41.13%) as lean MASLD and 83 (58.87%) as overweight MASLD. Significant fibrosis was observed in 121 of the 361 PWH, including 75 of the 141 with MASLD, 28 of the 58 with lean MASLD, and 47 of the 83 with overweight MASLD. Among PWH with MASLD, independent risk factors for significant liver fibrosis included higher alanine aminotransferase levels and the presence of type 2 diabetes. Among PWH with lean MASLD, independent risk factors for significant liver fibrosis included elevated aspartate aminotransferase levels and the administration of non-nucleoside reverse transcriptase inhibitors.

CONCLUSIONS

Significant liver fibrosis is highly prevalent among PWH and MASLD. Multiple risk factors are associated with significant liver fibrosis among PWH. These findings underscore the importance of early identification and management of liver fibrosis in PWH.

CLINICAL TRIALS REGISTRATION

NCT04215926.