LAUSR

BACKGROUND AIMS The current prevalence of fatty liver disease (FLD) due to alcoholic (AFLD) and non-alcoholic (NAFLD) origins in US persons with HIV (PWH) is not well defined. We prospectively evaluated the burden of fatty liver disease and hepatic fibrosis in a diverse cohort of PWH. APPROACH RESULTS Consenting participants in outpatient HIV clinics in 3 centers in the US underwent detailed phenotyping including liver ultrasound and vibration-controlled transient elastography for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). The prevalence of AFLD, NAFLD, clinically significant and advanced fibrosis were determined. Uni- and multivariate logistic regression models were used to evaluate factors associated with the risk of NAFLD. RESULTS Of 342 participants, 95.6% were on ART and 93.9% had adequate viral suppression, 48.7% (95% CI 43%-54%) had steatosis by ultrasound, and 50.6% (95% CI 45%-56%) had steatosis by CAP ≥263 dB/m. NAFLD accounted for 90% of FLD. In multivariable analysis, older age, higher BMI, diabetes, and higher ALT but not ART or CD4+ cell count, were independently associated with increased NAFLD risk. In all PWH with fatty liver, the frequency of LSM 8-12 kPa was 13.9% (95% CI 9%-20%) and ≥12 kPa 6.4% (95% CI 3%-11%), with similar frequency of these LSM cutoffs in NAFLD. CONCLUSIONS Nearly half of virally-suppressed PWH have FLD, 90% of which is due to NAFLD. A fifth of PWH with FLD has clinically significant fibrosis and 6% have advanced fibrosis. These data lend support to systematic screening for high-risk NAFLD in PWH.