Prevalence and risk factors of metabolic associated fatty liver disease in people living with HIV in China.

BACKGROUND AND AIM The new definition for metabolic fatty liver disease (MAFLD), formerly named nonalcoholic fatty liver disease (NAFLD), would undoubtedly have significant influence on diagnosis, epidemiology and new drug research. We investigated the prevalence and risk factors of MAFLD in people living with HIV (PLWH). METHODS In this cross-sectional study, transient elastography was performed in PLWH. Exclusion criteria included the absence of significant alcohol intake, HBV and HCV infection. NAFLD was diagnosed as controlled attenuation parameter (CAP) ≥248 dB/m by transient elastography, and MAFLD was defined according to the 2020 international consensus. Advanced fibrosis was defined as liver stiffness measurement (LSM) ≥10 kPa. RESULTS Among the 361 PLWH enrolled, the prevalence of NAFLD and MAFLD were 37.67% and 34.90%, respectively. Compared with the non-MAFLD group, the prevalence of elevated alanine aminotransferase (ALT) level (44.44% vs. 16.17%, P<0.001) and advanced fibrosis (19.05% vs. 2.55%, P<0.001) were significantly higher in the MAFLD group. A positive correlation between LSM and CAP values was found in the MAFLD group (rs =0.350, P<0.001), but not in the non-MAFLD group. In multivariate analysis, independent risk predictors for MAFLD were higher ALT level (odds ratio [OR] 1.015, 95% CI 1.002-1.028, P=0.019), higher uric acid (OR 1.005, 95% CI 1.002-1.009, P=0.003), higher total cholesterol (OR 1.440, 95% CI 1.050-1.974) and greater waist to height ratio (OR 1.359, 95% CI 1.219-1.515, P<0.001). CONCLUSIONS A third of PLWH had MAFLD, which was highly accordant with the prevalence of NAFLD. Routine screening for MAFLD is necessary in PLWH.