The association of steatotic liver disease with cardiometabolic criteria and cardiovascular disease risk in a large cohort of people living with human immunodeficiency virus.

Background & Aims: Steatotic liver disease (SLD), both metabolic dysfunction-associated liver disease (MASLD) without or with alcohol-associated liver disease (MetALD), is common in people with HIV (PWH) and associated with increased risk of cardiovascular disease (CVD). Methods: Clinical and laboratory data were collected prospectively. MASLD was defined as SLD with ≥1 cardiometabolic risk factors (CMRF) and non-significant alcohol use. CVD risk was assessed by five 10-year risk scores (Framingham CVD score, 2013 ASCVD score, and PREVENT scores for total CVD, ASCVD, and heart failure) and one 5-year CVD score (D:A:D). Those without SLD were compared to MASLD and MetALD. Results: Among 991 PWH without history of CVD, MASLD was present in 40% and MetALD in 9%. At least 4 CMRF were present in 55% of those with MASLD, 61% MetALD compared to 29% without SLD. Those with MASLD had higher PREVENT total CVD score than those without SLD and similarly for mean PREVENT ASCVD and heart failure scores. Those with MASLD also had higher mean risk than those without SLD by Framingham CVD score, 2013 ASCVD score, and D:A:D score. Conversely, those with MetALD and those without SLD had similar CVD risk scores. 10-year CVD risk level by PREVENT score was generally least. Conclusions: CMRF are very common in PWH, with MASLD or MetALD frequently having multiple CMRF. The PREVENT scores showed higher 10-year CVD, ASCVD, and heart failure risk in those with MASLD versus those without SLD.