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. 2025 Jul 23.
doi: 10.1111/hiv.70079. Online ahead of print.

Metabolic dysfunction-associated liver disease predicts incident liver fibrosis in people with HIV mono-infection: A cohort study

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

Metabolic dysfunction-associated liver disease predicts incident liver fibrosis in people with HIV mono-infection: A cohort study

Juliana Fittipaldi et al. HIV Med. .

Abstract

Introduction: 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).

Methods: 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.

Results: 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/m2 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]).

Conclusion: MASLD increased the risk of liver fibrosis in people with HIV mono-infection under c-ART.

Keywords: HIV; fibrosis; longitudinal studies; non‐alcoholic fatty liver disease.

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