Abstract
BACKGROUND AND AIM: Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of liver-related morbidity and mortality in people living with HIV/AIDS infection (PLHIV), with the advent of newer antiretroviral drugs. However, the metabolic alterations, biochemical analysis, and associated significant fibrosis, when compared to primary MASLD, remain poorly understood. We conducted a study comparing PLHIV with MASLD and primary MASLD subjects. METHODS: We enrolled 120 consecutive PLHIV with MASLD and 120 age- and sex-matched primary MASLD patients based on the MASLD diagnostic criteria. All patients underwent evaluation of metabolic parameters, anthropometric assessment, ultrasonography, and transient elastography. Significant and advanced fibrosis was defined as transient elastography (TE)≥ 8.2 kPa and ≥ 9.7 kPa, respectively. RESULTS: The metabolic risk factors (diabetes mellitus, systemic hypertension, dyslipidemia, and metabolic syndrome) were comparable between the two groups. "Lean" MASLD was more prevalent in the PLHIV group (p<0.001). Hand-grip strength was comparable among groups (p=0.728). Visceral fat (p<0.001), BMI (p<0.001), waist circumference (p<0.001), hip circumference (p<0.001), and waist-hip ratio (p=0.004) were significantly higher in the primary MASLD group. Significant and advanced fibrosis was higher in the PLHIV with MASLD compared to the primary MASLD group (p=0.026). CONCLUSION: Despite having a comparable metabolic profile and lower body fat, PLHIV tends to have conspicuously higher "lean" MASLD and more significant or advanced liver fibrosis compared to primary MASLD. There is an unmet need for active screening and aggressive treatment of PLHIV with MASLD, mainly because they tend to have a higher number of "lean" MASLD.