Prevalence of metabolic dysfunction-associated fatty liver disease, and its impact on health-related quality of life in people living with HIV

Background The prevalence of metabolic risk factors and non-alcoholic fatty liver disease (NAFLD) is high among people living with HIV (PLWH). However, the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its impact on health-related quality of life (HRQL) in PLWH remains unestablished. Methods A total of 282 PLWH on ART were prospectively enrolled. MAFLD was defined as the presence of hepatic steatosis and either overweight/obesity, lean/normal weight with additional risk abnormalities or type 2 diabetes. Hepatic steatosis and fibrosis were assessed by vibration-controlled transient elastography (VCTE). The HRQL was measured by the generic EQ-5D-5L questionnaire. Results The prevalence of MAFLD in the cohort was 26.6% (n=75). The median CAP in MAFLD was 320 dB/m. PLWH and MAFLD with type 2 diabetes showed the highest median LSM values (6.3 [IQR 6.2-7.8], p=0.010). Overall, HIV-related parameters including CD4 count, viral load and treatment regimen were not different between MAFLD and non-MAFLD. PLWH and MAFLD reported significantly lower HRQL (UI-value) compared to non-MAFLD (0.85±0.19 vs. 0.91±0.13, p=0.008). In a multivariable analysis, MAFLD remained an independent predictor of an impaired HRQL (UI-value) in PLWH (beta=−0.170, 95 CI −0.296, −0.030, p=0.016). Conclusion PLWH exhibit a high prevalence of MAFLD and report a significantly lower HRQL compared to PLWH in the absence of MAFLD. Risk-stratification of PLWH according to hepatic steatosis and MAFLD will help to prioritize preventive measures that are likely to support somatic and quality of life aspects. Publication History Article published online: 18 January 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany