Sex Assigned at Birth Influences MASLD Risk with Fibrosis in HIV Patients
Overview
In a large cohort of persons with HIV (PWH), men exhibited a higher prevalence of metabolic dysfunction-associated steatotic liver disease with clinically significant fibrosis (MASLD-CSF) compared to women. Female sex was independently protective against MASLD-CSF, while diabetes, hyperlipidemia, and increased waist circumference were significant risk factors.
Background
Metabolic dysfunction-associated steatotic liver disease (MASLD) is common among persons with HIV and is linked to adverse outcomes including fibrosis and cirrhosis. MASLD is defined by hepatic steatosis with metabolic risk factors and no other liver disease cause. Prior studies in the general population show men have higher MASLD risk than premenopausal women, but data in PWH, especially accounting for menopause status, are limited. Understanding sex and menopause influences on MASLD in PWH is critical for targeted screening and management.
Data Highlights
Characteristic
Men (n=709)
Women (n=255)
P-value
Median Age (years)
55.1
56.6
0.08
Black Race (%)
52
52
Not specified
MASLD-CSF Prevalence (%)
10.6
5.5
0.02
Odds Ratio for MASLD-CSF
Diabetes: 3.26 (2.01–5.30), P < .0001 Hyperlipidemia: 1.97 (1.14–3.39), P = .02 High Waist Circumference: 4.59 (2.12–9.93), P < .0001 Female Sex: 0.43 (0.23–0.81), P = .01
Key Findings
Men with HIV had nearly double the prevalence of MASLD-CSF compared to women (10.6% vs 5.5%).
Female sex assigned at birth was independently associated with lower odds of MASLD-CSF (OR 0.43).
Risk factor effect sizes and associations varied by sex and menopausal status subgroups.
Menopause status was self-reported; pre-/perimenopausal women had different risk profiles than postmenopausal women.
Clinical Implications
Clinicians should consider male sex, diabetes, hyperlipidemia, and elevated waist circumference as key indicators for MASLD screening in PWH. Female sex appears protective, but menopausal status may modify risk, underscoring the need for tailored risk stratification. Early identification of MASLD-CSF can guide interventions to prevent progression to advanced liver disease.
Conclusion
Sex assigned at birth significantly influences MASLD risk and fibrosis severity in persons with HIV, with men at higher risk. Incorporating sex and metabolic risk factors into screening strategies may improve detection and management of MASLD in this population.
References
HIV NASH CRN Study 2024 -- Sex Assigned at Birth Influences MASLD Risk in HIV
by Kara Wegermann, Ayako Suzuki, Elisa Sarmiento, LaKeisha Boyd, Yang Li, Laura A Wilson, Audrey Lloyd, Paula Debroy, Jennifer C Price, Tinsay Woreta, Holly Crandall, Richard K Sterling, Rohit Loomba, Naga Chalasani, Jordan E Lake
