Increasing evidence suggests fatty liver disease and metabolic conditions fall along a spectrum. An entity of metabolic associated fatty liver disease (MAFLD) has been recently proposed. We investigated the prevalence and factors associated with MAFLD, and associations with cardiovascular disease (CVD) in older people living with HIV(PWH).
We conducted a cross-sectional assessment of CVD risk (epicardial fat tissue, coronary calcium score (CAC) and 10-year atherosclerotic CVD score (ASCVD)) in participants aged >50 years from March 2018 to September 2019, in an aging HIV cohort in Bangkok, Thailand. PWH with significant alcohol consumption and hepatitis infections were excluded. Transient elastrography was performed, and non-alcohol fatty liver disease (NAFLD) was defined as controlled attenuation parameter (CAP) ?248 dB/m. MAFLD diagnosis was based on 2020 International Consensus criteria. The discriminatory ability of MAFLD and NAFLD to identify higher epicardial fat volume (defined as >median value of 100 cm[sup]…[/sup]3) was assessed using the area under the receiver operating characteristic (AROC) curve.
A total of 319 PWH (37% female) with median (interquartile range [IQR]) age 54 (52-60) years, and CD4 of 613 (467-804) cells/mm…3 and were included. Most (98%) were virally suppressed. MAFLD and NAFLD prevalence was 35% and 38%, respectively. Epicardial fat volume was significantly higher in PWH with MALFD than those without MAFLD (mean ±SD, 113.6 ±38.7 vs. 98.9 ±39.7 cm3, p<0.001). Liver stiffness (5.8 [4.8-7.3) vs. 5.4 [4.4-6.8] kPa, p=0.11), 10-year ASCVD risk (6.7% [3.8-14.0] vs. 5.9% [2.8-11.4], p=0.09) and CAC were comparable between PWH by MAFLD status. In a multivariable model, higher albumin (odds ratio [OR]=1.99, 95%CI 1.21-3.29), epicardial fat volume >100 cm…3 (OR=2.41, 95%CI 1.42-4.09), and CD4/CD8 ratio >1 (OR=0.55, 95%CI 0.32-0.97), were significantly associated with MAFLD. In a model adjusted for confounders, epicardial fat volume >100 cm3 showed similar discriminative ability for both MAFLD (AROC: 0.699, 95%CI 0.642-0.757) and NAFLD (AROC: 0.698, 95%CI 0.641-0.755, p=0.89).
In older PWH, >33% met criteria for MAFLD, so routine screening of metabolic disease in this population remains highly relevant. The association of MAFLD with epicardial fat tissue is consistent with previous evidence suggesting CVD risk is higher in those with fatty liver disease.