Author information

• ¹Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
• ²Division of Division of Gastroenterology and Hepatology, John Hopkins University, Baltimore, Maryland, USA.
• ³Division of Infectious Diseases, Department of Medicine, UTHealth, Houston, Texas, USA.
• ⁴Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
• ⁵Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
• ⁶Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
• ⁷Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA.
• ⁸Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, USA.
• ⁹Division of Gastroenterology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
• ¹⁰Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, USA.
• ¹¹Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, USA.
• ¹²Division of Infectious Diseases, John Hopkins University, Baltimore, Maryland, USA.
• ¹³The Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California, USA.

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been proposed as a replacement term for NAFLD.

Aims: To assess the effects of this new nomenclature on the prevalence and distribution of different SLD categories in people with HIV (PWH) and identified factors associated with MASLD and clinically significant fibrosis (CSF).

Methods: PWH were prospectively enrolled from 9 US centres and underwent clinical evaluation and vibration-controlled transient elastography for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). SLD was defined as CAP ≥ 263 dB/m, CSF as LSM of ≥8 kPa, and advanced fibrosis (AF) as LSM ≥ 12 kPa. The prevalence of SLD, MASLD, metabolic dysfunction and alcohol-associated liver disease (MetALD), ALD, cryptogenic (cSLD), CSF and AF were determined. Uni- and multivariate logistic regression models were used to assess factors associated with MASLD and CSF risk.

Results: Of 1065 participants, 74% were male, mean (SD) age 51.6 ± 11.9 years, 46% non-Hispanic Black and 74% with undetectable HIV RNA. The prevalence of SLD was 52%, MASLD 39%, MetALD 10%, ALD 3%, CSF 15% and AF 4%. Only 0.6% had cSLD. Black race was protective whereas obesity, ALT and AST levels were associated with increased risk of MASLD and CSF in MASLD. HIV or antiretroviral therapy did not affect MASLD risk.

Conclusions: MASLD and MetALD are the dominant causes of SLD in PWH, affecting almost half. Application of the new nomenclature resulted in minimal change in the proportion of patients with MASLD who would have been diagnosed previously with NAFLD.