Prevalence and Correlates of Steatotic Liver Disease Among People With HIV in Uganda.

BACKGROUND: Liver disease is an important cause of morbidity and mortality among people with HIV (PWH). Steatotic liver disease (SLD) is a leading cause of liver disease among PWH in the Global North. However, there is a dearth of data on the epidemiology of SLD in sub-Saharan Africa. METHODS: We analyzed computed tomography images from a completed cohort study composed of ambulatory people with and without HIV. We defined SLD as 1 or more of the following: mean liver attenuation (density) <40 Hounsfield units, mean liver to mean spleen attenuation ratio <1, or a Hounsfield unit difference <1 between the mean attenuation values of the liver and spleen. We fit multivariable regression models to evaluate the association of HIV with SLD. In a subanalysis to explore HIV-specific effects, we excluded those who reported high-risk alcohol consumption. RESULTS: A total of 579 participants had interpretable liver images. The prevalence of SLD was low overall (22/579, 3.8%) and higher among PWH as compared with people without HIV (5.4% vs 2.3%, P = .056). In multivariable regression models, PWH undergoing antiretroviral therapy were more likely to have SLD (adjusted odd ratio, 2.79; 95% CI, 1.10-7.09; P = .031), even after exclusion of people with high-risk alcohol consumption (adjusted odd ratio, 2.96; 95% CI, 1.00-8.70; P = .048). CONCLUSIONS: We found a low overall prevalence of SLD in Uganda, but older PWH undergoing antiretroviral therapy had a higher prevalence of SLD than those without HIV. Variation in the prevalence of SLD in the African region may be due to the variability in the methods used.