Metabolic Dysfunction-Associated Steatotic Liver Disease Is Associated With Impaired Health-Related Quality of Life...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in people with HIV (PWH), yet its impact on health-related quality of life (HRQoL) remains poorly characterized. We evaluated the association between MASLD and both generic and liver-specific HRQoL.

We conducted a cross-sectional analysis within a national multicenter cohort of PWH. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) plus at least metabolic comorbidity and significant liver fibrosis as liver stiffness measurement ≥8 kPa on FibroScan. Generic HRQoL was assessed using the Short Form-36 and liver-specific HRQoL using the Chronic Liver Disease Questionnaire (CLDQ). Adjusted estimated mean differences were estimated using multivariable linear regression.

Among 519 participants, the prevalence of MASLD and significant liver fibrosis was 41.4% and 7.2%, respectively. MASLD was independently associated with lower generic HRQoL, including reduction of physical functioning (-4.6; 95% confidence interval [CI] -9.12 to -0.01) and general health (-4.5; 95% CI -8.58 to -0.48) on the Short Form-36. Liver-specific HRQoL was more affected; MASLD was associated with a lower overall CLDQ score (-0.29; 95% CI -0.49 to -0.09), driven by worse fatigue, systemic symptoms, emotional symptoms, and worry. Among PWH with MASLD, increasing metabolic comorbidity burden was associated with a dose-response decline in physical HRQoL, whereas liver-specific HRQoL did not differ across comorbidity strata. Significant fibrosis was associated with lower CLDQ activity (-0.62; 95% CI -1.20 to -0.05) and worry (-0.60; 95% CI -1.15 to -0.05).

In PWH, MASLD is associated with impaired HRQoL, particularly fatigue, systemic symptoms, and emotional well-being. Greater metabolic burden and liver fibrosis further worsen patient-reported outcomes.