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Published on: September 11, 2019
Metabolic dysfunction-associated liver disease predicts incident liver fibrosis in people with HIV mono-infection: A
Juliana Fittipaldi1, Sandra W Cardoso1, Estevão Portela Nunes1
1Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
Introduction:
Metabolic dysfunction-associated liver disease (MASLD) might progress to cirrhosis. We aimed to evaluate the association of MASLD with the risk of developing clinically significant fibrosis (CSF) in people living with HIV (PLWH).
Methods:
PLWH have been followed up since 2015 in the PROSPEC-HIV cohort (NCT02542020) with questionnaires, blood samples, and transient elastography (TE) on the same day. Participants with viral hepatitis, who were c-ART naïve, those with CSF at baseline or unreliable TE examinations and who lost follow-up were excluded. Liver steatosis and fibrosis were assessed by TE-Controlled Attenuation Parameter (CAP) and TE-liver stiffness measurement (LSM), respectively. MASLD was defined as the presence of steatosis (CAP ≥263 dB/m) at baseline with at least one cardiometabolic risk factor without hazardous alcohol intake [Alcohol Use Disorders Identification Test (AUDIT) score <8]. The primary outcome was the development of CSF (LSM ≥8.0 kPa) during follow-up. Kaplan-Meier curves and Cox proportional hazards multivariate models were performed.
Results:
A total of 304 participants with HIV mono-infection under c-ART and without liver fibrosis (43.4% male, median [interquartile range, IQR] age = 44 [IQR, 36-52] and body mass index [BMI] = 25.6 [23.0-29.0] kg/m2 and 17.8% with MASLD) were included. During a median follow-up of 7.4 (IQR, 6.0-8.3) years, 11.8% (n = 36) participants developed CSF. The cumulative incidence of CSF at the 8th year was higher in PLWH with MASLD than in those without (30.1% [95% CI, 18.0-47.6] vs. 8.8% [95% CI, 5.4-14.2], p < 0.001). MASLD at baseline was significantly associated with the incidence of CSF in a multivariate Cox model (adjusted hazard ratio [aHR] = 2.92 [95% CI, 1.40-6.09]).
Conclusion:
MASLD increased the risk of liver fibrosis in people with HIV mono-infection under c-ART.
Insights
Metabolic dysfunction-associated liver disease (MASLD) significantly increases the risk of developing liver fibrosis in people with HIV. Early identification and management of MASLD are crucial for this population.
Area of Science:
- Hepatology
- Infectious Diseases
- Metabolic Disorders
Background:
- Metabolic dysfunction-associated liver disease (MASLD) can progress to cirrhosis.
- People living with HIV (PLWH) are at increased risk for liver disease.
- Evaluating MASLD's impact on fibrosis development in PLWH is critical.
Purpose of the Study:
- To assess the association between MASLD and the risk of developing clinically significant fibrosis (CSF) in PLWH.
- To identify risk factors for liver fibrosis progression in HIV-infected individuals.
Main Methods:
- Prospective cohort study (PROSPEC-HIV) of PLWH on c-ART.
- Liver steatosis and fibrosis assessed using transient elastography (TE) with CAP and LSM.
- MASLD defined by steatosis and cardiometabolic risk factors; CSF defined by LSM ≥8.0 kPa.
Main Results:
- MASLD was present in 17.8% of 304 PLWH at baseline.
- Higher cumulative incidence of CSF observed in PLWH with MASLD (30.1%) versus without (8.8%) over 8 years.
- MASLD significantly associated with increased CSF incidence (aHR = 2.92).
Conclusions:
- MASLD is an independent risk factor for liver fibrosis development in PLWH on c-ART.
- Findings highlight the importance of managing metabolic health in PLWH to prevent liver disease progression.
