Prevalence and Correlates of Steatotic Liver Disease Among People With HIV in Uganda

Liver disease is an important cause of morbidity and mortality among people with HIV (PWH). Steatotic liver disease (SLD) is a leading cause of liver disease among PWH in the Global North. However, there is a dearth of data on the epidemiology of SLD in sub-Saharan Africa.

We analyzed computed tomography images from a completed cohort study composed of ambulatory people with and without HIV. We defined SLD as 1 or more of the following: mean liver attenuation (density) <40 Hounsfield units, mean liver to mean spleen attenuation ratio <1, or a Hounsfield unit difference <1 between the mean attenuation values of the liver and spleen. We fit multivariable regression models to evaluate the association of HIV with SLD. In a subanalysis to explore HIV-specific effects, we excluded those who reported high-risk alcohol consumption.

A total of 579 participants had interpretable liver images. The prevalence of SLD was low overall (22/579, 3.8%) and higher among PWH as compared with people without HIV (5.4% vs 2.3%, P = .056). In multivariable regression models, PWH undergoing antiretroviral therapy were more likely to have SLD (adjusted odd ratio, 2.79; 95% CI, 1.10-7.09; P = .031), even after exclusion of people with high-risk alcohol consumption (adjusted odd ratio, 2.96; 95% CI, 1.00-8.70; P = .048).

We found a low overall prevalence of SLD in Uganda, but older PWH undergoing antiretroviral therapy had a higher prevalence of SLD than those without HIV. Variation in the prevalence of SLD in the African region may be due to the variability in the methods used.