Female Sex is Protective Against MASLD With Clinically Significant Fibrosis in a Large Cross-sectional Cohort of Persons With HIV - Scorecard - MDSpire
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Female Sex is Protective Against MASLD With Clinically Significant Fibrosis in a Large Cross-sectional Cohort of Persons With HIV
Clinical Scorecard: Sex Assigned at Birth Influences the Risk of MASLD With Clinically Significant Fibrosis in a Large Cohort of Individuals Living With HIV
Systemic inflammation, gut dysbiosis, body composition changes (e.g., HIV-related lipodystrophy), antiretroviral therapy effects
Target Population
Persons living with HIV (PWH) with suppressed HIV-1 RNA on ART
Care Setting
HIV clinical care and liver disease screening settings
Key Highlights
Men with HIV have higher prevalence of MASLD-CSF compared to women, especially premenopausal women.
Diabetes, hyperlipidemia, and elevated waist circumference are strongly associated with increased odds of MASLD-CSF in PWH.
Female sex is independently protective against MASLD-CSF in PWH; menopause status influences risk but requires further study.
Guideline-Based Recommendations
Diagnosis
Use transient elastography (TE) to assess hepatic steatosis and liver stiffness in PWH.
Define MASLD by CAP ≥ 263 dB/m plus ≥1 cardiometabolic risk factor and low alcohol use (AUDIT score <8).
Identify clinically significant fibrosis as TE liver stiffness measurement ≥ 8 kPa.
Management
Target screening for MASLD-CSF in men with diabetes, hyperlipidemia, and waist circumference above sex-specific cutoffs (men: 94 cm, women: 80 cm).
Consider sex and menopausal status when assessing MASLD risk in PWH.
Monitoring & Follow-up
Monitor metabolic risk factors including diabetes and lipid profiles regularly in PWH.
Assess liver fibrosis progression using transient elastography in high-risk individuals.
Risks
Increased risk of MASLD-CSF associated with diabetes, hyperlipidemia, and elevated waist circumference.
Men have higher risk of MASLD-CSF than women; risk in women increases post-menopause.
MASLD in PWH is linked to frailty, cardiovascular events, and reduced quality of life.
Patient & Prescribing Data
Persons living with HIV on antiretroviral therapy with suppressed viral load
ART initiation may differentially affect body mass index by sex; women may experience greater BMI increase. Metabolic risk factor management is critical to reduce MASLD-CSF risk.
Clinical Best Practices
Incorporate sex assigned at birth and menopausal status into MASLD risk stratification for PWH.
Screen men with HIV who have diabetes, hyperlipidemia, or elevated waist circumference for MASLD-CSF using transient elastography.
Address modifiable metabolic risk factors aggressively to prevent progression of MASLD in PWH.
Recognize the need for further research on MASLD risk in premenopausal women with 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
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