Diabetes and risk of significant fibrosis in adults with HIV and metabolic dysfunction-associated steatotic liver disease: a prospective cohort study

Background Limited data exist on whether the presence of type-2 diabetes mellitus (T2DM) increases the risk of significant liver fibrosis (LF) among people with HIV (PWH) and metabolic dysfunction-associated steatotic liver disease (MASLD). This study examined liver stiffness progression and significant LF risk according to T2DM status in PWH with MALSD (PWH-MASLD) diagnosed via vibration-controlled transient elastography (VCTE). Methods PWH who had MASLD and had ≥2 VCTE measurements during the follow-up (median duration 4 years) were included. Change in liver stiffness measurement (LSM) from baseline (ΔLSM) was evaluated using a linear mixed-effects model. Multivariable Poisson regression was used to evaluate association between baseline T2DM and significant LF incidence (LSM ≥7.5 kPa). Results Among 345 PWH with MASLD (35% female), 97 (28%) had T2DM at baseline. In adjusted analysis, LSM declined modestly over time [mean −0.15 kPa/year (95% CI −0.28, −0.01)]. The ΔLSM over time was not associated with baseline T2DM (Pinteraction = 0.40). Among 253 PWH-MASLD without LF at baseline, the incidence of LF was 3.89 [95% CI 2.79–5.41]/100 person-years. Participants with baseline T2DM had a >3-fold higher risk of significant LF compared with those without T2DM [adjusted incidence risk ratio (aIRR): 3.35, 95% CI: 1.67–6.75). Time-updated BMI (per kg/m2 increase) was also associated with significant LF (aIRR, 1.10, 95% CI 1.03–1.18). Conclusions Despite stable LSM over 4 years of follow-up, PWH with MASLD and T2DM have a significantly higher risk of LF. Prioritizing this population for intensive monitoring and treatments interventions may help mitigate liver disease progression.