Fibrosis stage higher among people living with HIV and MASLD

The extent of liver fibrosis appears to be higher among people living with HIV (PWH) who have metabolic dysfunction-associated steatotic liver disease (MASLD), despite lower NAFLD activity score (NAS) and less pronounced histological drivers of fibrosis, than among their counterparts who have no HIV, according to a study.

For the study, researchers examined 107 liver biopsies from PWH with MASLD (MASLD-PWH) and 107 biopsies from individuals with MASLD and without HIV (MASLD controls). These two groups were matched according to age at biopsy, race/ethnicity, sex, type 2 diabetes, BMI, and alanine aminotransferase (ALT) level. Biopsies were scored using NAS.

Compared with MASLD controls, MASLD-PWH patients were more likely to have lower steatosis grade (odds ratio [OR], 0.65, 95 percent confidence interval [CI], 0.47–0.90; p=0.01), lower lobular inflammation grade (OR, 0.55, 95 percent CI, 0.34–0.89; p=0.02), less portal inflammation (OR, 0.42, 95 percent CI, 0.25–0.72; p=0.002), and less ballooned hepatocytes (OR, 0.60, 95 percent CI, 0.41–0.88; p=0.01).

The MASLD-PWH group also had lower NAS (OR, 0.69, 95 percent CI,0.56–0.85; p<0.001) and numerically lower prevalence of steatohepatitis (OR, 0.84, 95 percent CI, 0.68–1.03; p=0.09).

Multivariate analysis showed that relative to MASLD control, MASLD-PWH was associated with significantly less steatosis (OR, 0.66; p=0.03), portal inflammation (OR, 0.34; p=0.001), and ballooned hepatocytes (OR, 0.55; p=0.01) but higher fibrosis stage (OR, 1.42; p=0.03).

The findings indicate that HIV-specific factors beyond hepatic necroinflammation may contribute to fibrosis progression in MASLD-PWH.