Prevalence of steatotic liver disease phenotypes and liver fibrosis in people with HIV in Egypt.

BACKGROUND: Regional data on steatotic liver disease (SLD) in people with HIV (PWH) are scarce. This study aimed to determine the prevalence of SLD phenotypes and clinically significant fibrosis (CSF) in a cohort of Egyptian PWH. METHODS: A cross-sectional study was conducted on 531 PWH who attended the HIV clinic at Cairo University Hospitals between July 2022 and September 2023. Hepatic steatosis and fibrosis were assessed using vibration-controlled transient elastography (FibroScan). SLD was defined by a controlled attenuation parameter (CAP) ≥248 dB/m and CSF was defined by a liver stiffness measurement (LSM) ≥8 kPa. RESULTS: The prevalence of SLD was 26.0% (n=138/531), with metabolic dysfunction-associated SLD (MASLD) as the predominant phenotype (81.15%) followed by hepatitis C virus (HCV)-associated SLD (12.31%). The prevalence of CSF was significantly higher in patients with SLD (15.22%) compared with those without (3.56%). The risk for CSF was greatest among patients with HCV-associated SLD, with or without cardiometabolic risk factors (23.53%), followed by those with MASLD (15.18%). CONCLUSIONS: SLD is a common comorbidity among PWH in Egypt, predominantly driven by metabolic dysfunction. CSF was notably higher among those with MASLD and HCV coinfection, underscoring the need for integrating systematic SLD assessment into routine HIV care to enable early detection and management of progressive liver disease.