Prevalence and Risk Factors of Liver Fibrosis in HIV Patients with MASLD

Overview

This study assessed liver fibrosis prevalence and associated risk factors in 361 people with HIV (PWH) diagnosed with metabolic dysfunction–associated steatotic liver disease (MASLD). Significant liver fibrosis was common, especially among those with MASLD, with distinct risk factors identified for lean and overweight subgroups.

Background

Liver disease is a leading cause of non–AIDS-related mortality in people with HIV (PWH). Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized in PWH due to factors including HIV infection, antiretroviral therapy, and insulin resistance. Liver fibrosis, a precursor to cirrhosis and hepatocellular carcinoma, is often asymptomatic but critical to identify early. Noninvasive methods like transient elastography enable fibrosis assessment without biopsy.

Data Highlights

Key Findings

• Among 361 PWH, 39.06% were diagnosed with MASLD, with 41.13% classified as lean MASLD and 58.87% as overweight MASLD.
• Significant liver fibrosis (LSM ≥7.1 kPa) was present in 33.5% of all PWH and 53.2% of those with MASLD.
• Independent risk factors for significant fibrosis in PWH with MASLD included elevated alanine aminotransferase (ALT) levels and presence of type 2 diabetes.
• In lean MASLD patients, elevated aspartate aminotransferase (AST) levels and use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) were independently associated with significant fibrosis.
• Transient elastography proved effective for noninvasive assessment of liver fibrosis and steatosis in this population.

Clinical Implications

Clinicians should maintain a high index of suspicion for significant liver fibrosis in PWH, especially those with MASLD, regardless of BMI status. Routine liver fibrosis screening using transient elastography and monitoring of liver enzymes and metabolic comorbidities such as diabetes are recommended. Awareness of ART regimens, particularly NNRTIs, as potential fibrosis risk factors in lean MASLD patients may guide therapeutic decisions.

Conclusion

Significant liver fibrosis is highly prevalent among PWH with MASLD, including lean individuals, with distinct risk factors identified. Early detection and management of liver fibrosis in this population are crucial to prevent progression to cirrhosis and liver-related complications.

References

1. Study Authors/Shanghai Public Health Clinical Center/2024 -- Assessment of Liver Fibrosis Prevalence and Associated Risk Factors in Individuals with HIV and Metabolic Dysfunction-Related Steatotic Liver Disease