Establishment of a Risk Prediction Model for Metabolic Dysfunction-Associated Steatotic Liver Disease in People...

The development of metabolic dysfunction-associated steatotic liver disease (MASLD) in people living with HIV (PLWH) is more complex than in the general population. Despite this, PLWH are often excluded from large-scale MASLD studies. This study aims to develop and validate a nomogram for predicting the risk of MASLD in PLWH.

This retrospective cohort study included PLWH who attended the outpatient clinic at Ningbo Hospital of Integrated Traditional Chinese and Western Medicine. A total of 717 participants were randomly assigned at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) regression was employed to identify significant predictors of MASLD. A multivariable Cox regression model was then utilized to develop a nomogram for predicting the risk of MASLD. The performance of the nomogram was assessed using the concordance index (C-index), receiver operating characteristic curve, calibration plots, and decision curve analysis (DCA). Competing risk analysis was conducted to further validate the identified predictors.

The LASSO regression analysis identified eight independent predictors, including the antiretroviral therapy regimen, alanine aminotransferase, serum amylase, uric acid, triglycerides, high-density lipoprotein cholesterol, and CD4 and CD8 T lymphocyte counts. The Area Under the Curve (AUC) for 1-, 3-, and 5-year outcomes in the development cohort ranged from 0.793 to 0.830, while the validation cohort exhibited AUC ranging from 0.749 to 0.903. Calibration plots confirmed a robust agreement between the predicted and observed outcomes. The C-index and DCA indicated the superior prediction performance of the nomogram. This relationship remained statistically significant after using the competing risk analysis.

This study developed the first clinical nomogram specifically for PLWH based on the 2023 MASLD definition. The model is based on eight clinically accessible and objective variables, including HIV-specific parameters, and is intended for the early screening of MASLD within this population.