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. 2025 Oct 1;39(12):1721-1730.
doi: 10.1097/QAD.0000000000004250. Epub 2025 Jun 4.

Metabolic dysfunction-associated steatotic liver disease was associated with liver fibrosis in people with HIV from Brazil

Juliana Fittipaldi  1 , Sandra W Cardoso, Estevão Portela Nunes, Cristiane Fonseca De Almeida, Patricia Dias De Brito, Valdilea G Veloso, Beatriz Grinsztejn, Hugo Perazzo
Affiliations

Metabolic dysfunction-associated steatotic liver disease was associated with liver fibrosis in people with HIV from Brazil

Juliana Fittipaldi et al. AIDS. .

Abstract

Objective: 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).

Design: Cross-sectional study.

Methods: We analyzed data from the baseline visit of the PROSPEC-HIV-study (NCT02542020). People 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.

Results: 684 participants [47.8% male, median age= 45 [interquartile range (IQR), 36-53] years, 12% with diabetes and 13% with viral hepatitis coinfection] were included. The prevalence [95% confidence interval (CI)] of MASLD and CSLF were 19.3% [16.5-22.4] and 14.2% [11.8-17.0], respectively. In the multivariate analysis [odds ratio (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 + cell count <350 cells/mm 3 [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)].

Conclusion: 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.

Keywords: HIV; cardiometabolic risk factors; liver fibrosis; liver steatosis; nonalcoholic fatty liver disease.

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