Older people living with HIV: a population with high prevalence and severity of metabolic dysfunction-associated steatotic liver disease ‒ A cross-sectional study.

BACKGROUND: Among People Living With Human immunodeficiency virus (PLWH) chronic liver disease is a major cause of non-HIV-related death. Factors related to HIV and its treatment may amplify the impact of metabolic risk factors and aging, thus leading to a high frequency of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) among this population. This study aimed to evaluate the frequency and associated factors of MASLD and its severity in older PLWH, and secondarily, to assess the frequency of MASLD-related fibrosis. METHODS: This cross-sectional study included older PLWH followed at a referral center in northeastern Brazil. Hepatic steatosis was assessed by abdominal ultrasonography and liver fibrosis by point Shear-Wave Elastography (pSWE). Multivariable Poisson regression was performed to identify factors independently associated with hepatic steatosis and steatosis severity. RESULTS: Ninety-two older PLWH were included. Hepatic steatosis was identified in 53.3% (n = 49) of participants, of whom 29 (53%) had moderate-to-severe steatosis. Significant fibrosis (F2 or greater) was identified in 10.6% of participants with steatosis who underwent elastography. Increased waist circumference, higher body mass index, metabolic syndrome, higher HbA1c and triglyceride levels were associated with hepatic steatosis. In multivariate analysis, increased waist circumference remained the factor most strongly associated with hepatic steatosis (PR = 4.69; 95% CI 1.53-14.38; p = 0.007). Factors associated with moderate-to-severe steatosis included metabolic and social factors, higher Alanine Aminotransferase (ALT) levels, dolutegravir use, absence of darunavir exposure and higher CD4 nadir. After adjustment, lipodystrophy (aPR = 1.63; 95% CI 1.04-2.56; p = 0.033) and higher Alanine Aminotransferase (ALT) levels (aPR = 1.03; 95% CI 1.01-1.04; p = 0.001) remained independently associated with greater steatosis severity. CONCLUSIONS: MASLD was highly prevalent among older PLWH, with a substantial proportion presenting moderate-to-severe steatosis and significant fibrosis. Metabolic and adiposity-related factors were independently associated with hepatic steatosis, while lipodystrophy and higher ALT levels were associated with greater steatosis severity.