Evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in a Cohort of Older People Living with HIV/AIDS

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is currently the leading cause of chronic liver disease, with an estimated prevalence of 30%. Among people living with HIV/AIDS (PLWHA), liver diseases are the main cause of non-AIDS-related mortality. Although viral hepatitis remains relevant, MASLD prevalence has been increasing in this group, with significant clinical impact. This study aimed to estimate MASLD prevalence and evaluate associated factors in a cohort of PLWHA aged 50 years or older. Cross-sectional study with 24 PLWHA aged ≥ 50 years, under sustained viral suppression and without viral hepatitis coinfection. Clinical, laboratory, and socioepidemiological data were collected via REDCap. Liver assessment included Doppler ultrasound, 2D-SWE elastography, and quantification of hepatic fat using USFF (Ultrasound Signal Fat Fraction) on a Samsung RS85 platform. Steatosis was defined as fat fraction ≥ 8.7%. Analyses were conducted in Stata/MP19 using the Wilcoxon test for quantitative and Fisher’s exact test for qualitative variables. Mean age 61 years; 83% cisgender men; 50% mixed-race/Black; 58% homosexual/bisexual. Mean CD4 count 833 cells/mm³, CD4/CD8 ratio 1.0, mean HIV infection duration 18 years, and 75% on ART for > 10 years. MASLD prevalence was 29%, with 12% reporting alcohol use. No statistically significant differences were found between groups with and without steatosis for most variables, except for CD4 nadir, which was higher in the steatosis group (546 vs. 218 cells/mm³; p = 0.008), possibly reflecting analysis bias, as two individuals were elite controllers with BMI > 30. BMI was higher in the steatosis group (32 vs. 24), though not statistically significant (p = 0.057). Despite the absence of statistical significance for most variables, higher BMI and CD4 nadir in the steatosis group suggest potential associations to be explored further. The small sample size may have limited statistical power. Future studies with larger samples are needed to identify specific risk factors for MASLD among PLWHA aged ≥ 50, a population still underrepresented in metabolic liver disease research.