Evaluation of Insulin Resistance Markers for Diagnosing Moderate to Severe Hepatic Steatosis in Patients With Human Immunodeficiency Virus Using Transient Elastography.

Background: Hepatic steatosis, commonly associated with metabolic dysfunction-associated steatotic liver disease, is a growing but underdiagnosed concern in people with human immunodeficiency virus (HIV). This study evaluates the diagnostic accuracy of insulin resistance markers (homeostatic model assessment for insulin resistance, triglyceride-glucose [TyG], triglyceride-glucose-body mass index [TyG-BMI], and triglyceride/high-density lipoprotein cholesterol indices) for identifying moderate to severe hepatic steatosis in people with HIV using transient elastography (FibroScan). Methods: We prospectively analyzed 235 people with HIV on antiretroviral therapy with suppressed viral loads (<50 RNA copies/mL). Moderate to severe hepatic steatosis was defined as a controlled attenuation parameter ≥269 dB/m. Insulin resistance markers were calculated and diagnostic performance was assessed using receiver operating characteristic curves. Results: Moderate to severe hepatic steatosis was detected in 48 patients (20.4%). These individuals had higher rates of diabetes, BMI, and waist circumference. Insulin resistance indices were significantly elevated in this group, with TyG-BMI demonstrating the highest diagnostic accuracy (area under the curve, 0.800 [95% confidence interval, .727-.873]), achieving 79.2% sensitivity and 61.3% specificity at a cutoff of 227.36. Conclusions: Insulin resistance markers, especially TyG-BMI, may serve as practical, noninvasive tools for identifying moderate to severe hepatic steatosis in people with HIV, particularly in resource-limited settings where transient elastography is unavailable.