Establishment of a Risk Prediction Model for Metabolic Dysfunction-Associated Steatotic Liver Disease in People Living with HIV in China

Purpose: The development of metabolic dysfunction-associated steatotic liver disease (MASLD) in people living with HIV (PLWH) is more complex than in the general population. Despite this, PLWH are often excluded from large-scale MASLD studies. This study aims to develop and validate a nomogram for predicting the risk of MASLD in PLWH. Patients and Methods: This retrospective cohort study included PLWH who attended the outpatient clinic at Ningbo Hospital of Integrated Traditional Chinese and Western Medicine. A total of 717 participants were randomly assigned at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) regression was employed to identify significant predictors of MASLD. A multivariable Cox regression model was then utilized to develop a nomogram for predicting the risk of MASLD. The performance of the nomogram was assessed using the concordance index (C-index), receiver operating characteristic curve, calibration plots, and decision curve analysis (DCA). Competing risk analysis was conducted to further validate the identified predictors. Results: The LASSO regression analysis identified eight independent predictors, including the antiretroviral therapy regimen, alanine aminotransferase, serum amylase, uric acid, triglycerides, high-density lipoprotein cholesterol, and CD4 and CD8 T lymphocyte counts. The Area Under the Curve (AUC) for 1-, 3-, and 5-year outcomes in the development cohort ranged from 0.793 to 0.830, while the validation cohort exhibited AUC ranging from 0.749 to 0.903. Calibration plots confirmed a robust agreement between the predicted and observed outcomes. The C-index and DCA indicated the superior prediction performance of the nomogram. This relationship remained statistically significant after using the competing risk analysis. Conclusion: This study developed the first clinical nomogram specifically for PLWH based on the 2023 MASLD definition. The model is based on eight clinically accessible and objective variables, including HIV-specific parameters, and is intended for the early screening of MASLD within this population.