Non-Hispanic Black Persons With HIV Have a Lower Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease and Clinically Significant Fibrosis Compared to Non-Hispanic White and Hispanic Individuals

Abstract Background Metabolic dysfunction–associated steatotic liver disease (MASLD) is a major cause of liver-related morbidity and mortality among people with human immunodeficiency virus (PWH). We aimed to determine the prevalence of MASLD and clinically significant fibrosis among PWH and investigate if racial and ethnic differences exist after adjustment for clinical risk factors and PNPLA3 genotype. Methods This cross-sectional analysis included adult PWH prospectively enrolled in 2 US multicenter studies from 2018 to 2023. MASLD was defined as a controlled attenuation parameter (CAP) score ≥263 dB/m with at least 1 cardiometabolic risk factor and clinically significant fibrosis as a liver stiffness measurement ≥8 kPa upon vibration-controlled transient elastography. Multivariable logistic regression analysis was performed to examine the association of race/ethnicity with the presence of MASLD and clinically significant fibrosis, adjusting for clinical risk factors and PNPLA3 genotype. Results Of the 996 participants, the mean age was 53. 9 years (standard deviation, 12 years) and 72% were male. The prevalence of MASLD and clinically significant fibrosis were 49% and 14%, respectively. Non-Hispanic Black (NHB) persons had the lowest prevalence of MASLD (43%) compared to non-Hispanic White (NHW) (53%) and Hispanic individuals (60%) (P. 001). Similarly, NHB persons had the lowest prevalence of clinically significant fibrosis (12%) compared to NHW (20%) and Hispanic individuals (13%) (P =. 005). After adjusting for clinical risk factors and PNPLA3 genotype, NHB had a lower odds of MASLD (odds ratio OR, 0. 39 95% confidence interval CI,. 23–. 66) and clinically significant fibrosis (OR, 0. 38 95% CI,. 20–. 71) compared to NHW persons. Conclusions NHB PWH have a lower risk of MASLD and clinically significant fibrosis compared to NHW and Hispanic individuals, even after controlling for clinical risk factors and PNPLA3 genotype.