Clinical Scorecard: Assessment of Liver Fibrosis Prevalence and Associated Risk Factors in Individuals with HIV and Metabolic Dysfunction-Related Steatotic Liver Disease
At a Glance
Category
Detail
Condition
Liver fibrosis in people with HIV (PWH) and metabolic dysfunction–associated steatotic liver disease (MASLD)
Key Mechanisms
HIV infection, chronic inflammation, antiretroviral therapy effects, insulin resistance, and metabolic hepatic damage leading to liver fibrosis
Target Population
People with HIV aged 18-70 years, including lean and overweight individuals with MASLD
Care Setting
Outpatient infectious disease clinics, specifically at Shanghai Public Health Clinical Center
Key Highlights
Significant liver fibrosis is highly prevalent among PWH with MASLD, including lean and overweight subgroups.
Independent risk factors for significant fibrosis in PWH with MASLD include elevated alanine aminotransferase (ALT) levels and type 2 diabetes.
In lean PWH with MASLD, elevated aspartate aminotransferase (AST) levels and use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) are independent risk factors for significant fibrosis.
Guideline-Based Recommendations
Diagnosis
Use transient elastography (liver stiffness measurement ≥ 7.1 kPa) to noninvasively assess significant liver fibrosis.
Employ abdominal ultrasonography and controlled attenuation parameter for steatosis evaluation.
Consider the FibroScan–aspartate aminotransferase (FAST) score to identify metabolic dysfunction–associated steatohepatitis (MASH) with significant fibrosis.
Management
Early identification and management of liver fibrosis in PWH is critical to prevent progression to cirrhosis and hepatocellular carcinoma.
Monitor and manage metabolic risk factors such as type 2 diabetes and liver enzyme elevations.
Review antiretroviral therapy regimens, especially NNRTI use in lean MASLD patients, to mitigate liver fibrosis risk.
Monitoring & Follow-up
Regular assessment of liver stiffness and steatosis in PWH with MASLD, including lean individuals.
Monitor liver enzymes (ALT, AST) as markers associated with fibrosis risk.
Surveillance for hepatic decompensation and hepatocellular carcinoma in patients with significant fibrosis.
Risks
Progression from MASLD to significant liver fibrosis increases risk of cirrhosis and hepatocellular carcinoma.
Certain ART drugs, particularly NNRTIs, may contribute to liver injury and fibrosis.
Chronic HIV-related inflammation and immune activation exacerbate liver fibrosis development.
Patient & Prescribing Data
People with HIV diagnosed with MASLD, including lean (BMI < 24 kg/m2) and overweight individuals
Non-nucleoside reverse transcriptase inhibitors are associated with increased risk of significant liver fibrosis in lean MASLD patients, suggesting the need for careful ART selection and monitoring.
Clinical Best Practices
Screen PWH for MASLD and liver fibrosis regardless of BMI status.
Utilize noninvasive diagnostic tools like transient elastography and FAST score for fibrosis assessment.
Address modifiable metabolic risk factors such as diabetes and elevated liver enzymes promptly.
Consider ART regimen adjustments to minimize hepatotoxicity, especially in lean MASLD patients.
Implement longitudinal monitoring to detect progression of liver disease early.
