Risk factors for advanced liver fibrosis among people living with HIV: a 5-year longitudinal study in Thailand

Advanced liver fibrosis (≥F3) is a significant health concern and is associated with an increased risk of mortality in people living with HIV (PLWH). This study aimed to evaluate the prevalence and factors associated with advanced liver fibrosis over a 5-year longitudinal period among PLWH in Thailand. A total of 1,032 PLWH aged ≥18 years from a Thai HIV cohort in Bangkok, Thailand were enrolled between June 15, 2010 and July 1, 2019. Liver stiffness measurements (LSM) were performed using transient elastography at baseline and at 5-year follow-up. The prevalence of liver fibrosis stages changed significantly between baseline and the 5-year follow-up (p = 0.04). The prevalence of significant liver fibrosis (F2) increased from 8.6% to 9.8% and ≥ F3 rose from 6.1% to 7.8% at the 5-year follow-up. In the multivariable analysis, older age, obesity, elevated AST, a lower platelet count, high glucose levels, lower HDL-C, HCV coinfection, and diabetes mellitus were associated with advanced liver fibrosis (≥F3). Our findings highlight a concerning trend of liver fibrosis progression among PLWH in Thailand, driven by older age, metabolic abnormalities, comorbid conditions, and coinfection. Surveillance among high-risk individuals is essential for the early identification of liver fibrosis progression.