Risk factors of metabolic dysfunction-associated fatty liver disease in people living with HIV receiving antiretroviral therapy.

OBJECTIVE: This study aimed to identify risk factors associated with the onset and progression of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) in People Living with Human Immunodeficiency Virus (PLWH). METHODS: Clinical and laboratory data were retrospective collected at 6 months, 1, 1.5, 2, and 3 years after ART initiation. Multivariable logistic regression was employed to identify MAFLD risk factors and evaluate ART's influence. RESULTS: Among the 740 participants (95% male, mean age 36.58 ± 13.93 years), with an average ART duration of 3.33 ± 4.56 years. Laboratory data at 6 months showed a CD4 count of (356.95 ± 98.76) cells/mm3, body mass index (BMI) of (22.87 ± 7.47) kg/m2, triglycerides (TG) of (1.53 ± 0.98) mmol/L and low-density lipoprotein cholesterol (LDL-c) of (2.45 ± 0.71) mmol/L. MAFLD detection rates by Hepatic Steatosis Index (HSI) and Zhejiang University indices (ZJU) increased with longer ART duration. Patients with>10% weight gain showed a notable rise from 48.80% at baseline to 87% after 3 years of ART. Independent risk factors for MAFLD included female, type 2 diabetes mellitus (T2DM) prior MAFLD, baseline BMI>24 kg/m2 and TG≥1.7 mmol/L, weight gain of 5-10% or >10% within one year, BMI≥24 kg/m2 and TG≥1.7 mmol/L at year 1. Protective factors included age>65 years, AZT and 3TC-based therapies. CONCLUSION: The prevalence of MAFLD as assessed by the HSI and ZJU indices increases steadily with ART and is strongly related to weight gains. These findings validate the effectiveness of these non-invasive tools for identifying key risk factors and underscore the necessity of continuous weight monitoring in contemporary ART-treated patients.