Prevalence and Correlates of Steatotic Liver Disease among People with HIV in Uganda

Introduction Liver disease is an important cause of morbidity and mortality among people with HIV (PWH). Steatotic liver disease (SLD) is a leading cause of liver disease among PWH in the global North. However, there is a dearth of data on the epidemiology of SLD in sub-Saharan Africa. Methods We analyzed computed tomography (CT) images from a completed cohort study comprised of ambulatory people with and without HIV. We defined SLD as one or more of the following: 1) mean liver attenuation (density) of < 40 Hounsfield Units (HU); 2) mean liver:mean spleen attenuation ratio <1; or 3) a difference of <1 HU between the mean attenuation values of the liver and spleen. We fit multivariable regression models to evaluate the association of HIV with SLD. In a sub-analysis to explore HIV-specific effects, we excluded those who reported high-risk alcohol consumption. Results A total of 579 had interpretable liver images. Prevalence of SLD was low overall (22/579, 3.8%), and higher among PWH compared with PWoH (5.4% vs. 2.3%, p=0.056). In multivariable regression models, PWH on ART were more likely to have SLD (AOR 2.79, 95%CI [1.10, 7.09], p=0.031), even after exclusion of people with high-risk alcohol consumption (AOR 2.96, 95%CI [1.00, 8.70], p=0.048). Conclusion We found a low overall prevalence of SLD in Uganda, but that older-age PWH on ART had a higher prevalence of SLD than those without HIV. Variation in the prevalence of SLD in the African region may be due to the variability in the methods used.