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, Brazil.
HIV Med. 2025 Jul 23. doi: 10.1111/hiv.70079.
Metabolic dysfunction-associated liver disease (MASLD) might progress to cirrhosis. We aimed to evaluate the association of MASLD with the risk of developing clinically significant fibrosis (CSF) in people living with HIV (PLWH).
PLWH have been followed up since 2015 in the PROSPEC-HIV cohort (NCT02542020) with questionnaires, blood samples, and transient elastography (TE) on the same day. Participants with viral hepatitis, who were c-ART naïve, those with CSF at baseline or unreliable TE examinations and who lost follow-up were excluded. Liver steatosis and fibrosis were assessed by TE-Controlled Attenuation Parameter (CAP) and TE-liver stiffness measurement (LSM), respectively. MASLD was defined as the presence of steatosis (CAP ≥263 dB/m) at baseline with at least one cardiometabolic risk factor without hazardous alcohol intake [Alcohol Use Disorders Identification Test (AUDIT) score <8]. The primary outcome was the development of CSF (LSM ≥8.0 kPa) during follow-up. Kaplan-Meier curves and Cox proportional hazards multivariate models were performed.
A total of 304 participants with HIV mono-infection under c-ART and without liver fibrosis (43.4% male, median [interquartile range, IQR] age = 44 [IQR, 36-52] and body mass index [BMI] = 25.6 [23.0-29.0] kg/m and 17.8% with MASLD) were included. During a median follow-up of 7.4 (IQR, 6.0-8.3) years, 11.8% (n = 36) participants developed CSF. The cumulative incidence of CSF at the 8th year was higher in PLWH with MASLD than in those without (30.1% [95% CI, 18.0-47.6] vs. 8.8% [95% CI, 5.4-14.2], p < 0.001). MASLD at baseline was significantly associated with the incidence of CSF in a multivariate Cox model (adjusted hazard ratio [aHR] = 2.92 [95% CI, 1.40-6.09]).
MASLD increased the risk of liver fibrosis in people with HIV mono-infection under c-ART.
代谢功能障碍相关肝病（MASLD）可能进展为肝硬化。我们旨在评估MASLD与HIV感染者（PLWH）发生临床显著纤维化（CSF）风险之间的关联。
自2015年起，在PROSPEC-HIV队列（NCT02542020）中对PLWH进行随访，同日收集问卷、血样并进行瞬时弹性成像（TE）检查。排除患有病毒性肝炎、未接受过抗逆转录病毒治疗（c-ART）、基线时存在CSF或TE检查结果不可靠以及失访的参与者。分别通过TE控制衰减参数（CAP）和TE肝脏硬度测量（LSM）评估肝脏脂肪变性和纤维化。MASLD定义为基线时存在脂肪变性（CAP≥263dB/m）且至少有一种心血管代谢危险因素且无有害酒精摄入[酒精使用障碍识别测试（AUDIT）评分<8]。主要结局是随访期间发生CSF（LSM≥8.0kPa）。绘制Kaplan-Meier曲线并进行Cox比例风险多变量模型分析。
共纳入304例接受c-ART治疗且无肝纤维化的HIV单一感染参与者（43.4%为男性，年龄中位数[四分位间距，IQR]=44[IQR，36 - 52]，体重指数[BMI]=25.6[23.0 - 29.0]kg/m²，17.8%患有MASLD）。在中位随访7.4（IQR，6.0 - 8.3）年期间，11.8%（n = 36）的参与者发生了CSF。患有MASLD的PLWH在第8年时CSF的累积发生率高于未患MASLD者（30.1%[95%置信区间，18.0 - 47.6]对8.8%[95%置信区间，5.4 - 14.2]，p<0.001）。在多变量Cox模型中，基线时的MASLD与CSF的发生率显著相关（调整后风险比[aHR]=2.92[95%置信区间，1.40 - 6.09]）。
在接受c-ART治疗的HIV单一感染人群中，MASLD增加了肝纤维化风险。
