Abstract
BACKGROUND: Men are at higher risk for metabolic dysfunction-associated steatotic liver disease (MASLD) with clinically significant fibrosis (CSF) than premenopausal women, but data are lacking in persons with HIV (PWH). The aim of this study was to discover prevalence and severity of MASLD in PWH by sex assigned at birth and menopausal status. METHODS: We examined participants from the prospective, cross-sectional HIV NASH CRN who had suppressed HIV-1 RNA, self-reported sex assigned at birth and menopause status, and underwent transient elastography (TE). The primary outcome was MASLD (controlled attenuation parameter [CAP] ≥ 263 dB/m, ≥1 cardiometabolic risk factor, Alcohol Use Disorders Identification Test score <8) with CSF (MASLD-CSF, TE Liver Stiffness Measurement ≥ 8 kPa). RESULTS: Nine hundred and sixty-four PWH were included: 709 men (73.5%) and 255 women (26.5%) with similar median ages (55.1 and 56.6 years, P-value = .08). The most common race was Black (52%). Women had lower prevalence of MASLD-CSF than men (5.5% vs 10.6%, P = .02). In a multivariable logistic regression model for MASLD-CSF, diabetes (OR 3.26 [95% confidence interval 2.01-5.30], P < .0001), hyperlipidemia (1.97 [1.14-3.39], P = .02), and waist circumference (WC) above sex-specific cutoff (women: 80 cm, men: 94 cm) (4.59 [2.12-9.93], P < .0001) were associated with higher odds of MASLD-CSF, while female sex was associated with lower odds (0.43 [0.23-0.81], P = .01). Variables and effect sizes associated with MASLD-CSF differed among sex/menopause subgroups. CONCLUSIONS: Female sex was protective against MASLD-CSF in PWH. Men with diabetes, hyperlipidemia, and high WC would be candidates for MASLD screening. Further studies of PWH with women, especially more young women, are needed.