CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

758

Evaluation of Different Noninvasive Models in Assessing Lean MAFLD Among PLWH Wei Xu 1 , Yinzhong Shen 2 1 Shanghai Public Health Clinical Center, Shanghai, China, 2 Fudan University, Shanghai, China Background: This study aimed to investigate prevalence of lean metabolic associated fatty liver disease (lean MAFLD) in people living with HIV(PLWH) and the value of ten diagnostic models in MAFLD among PLWH. Methods: Transient Elastography (Fibroscan), Controlled attenuation parameter (CAP) and ultrasonography were performed among PLWH. MAFLD was defined by the 2024 revised edition of the Chinese guidelines for prevention and treatment of MAFLD. Lean MAFLD was defined as a BMI<24kg/m 2 in patients with MAFLD. The SteatoText (ST), fatty liver index (FLI), NAFLD-liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), index of NAFLD(ION), ZJU index, NAFL screening score (NSS), K-NAFLD, visceral adiposity index (VAI) and Lipid Accumulation Product (LAP) were evaluated. The area under the receiver operating characteristic (AUROC) curve was used to evaluate the performance of them for diagnosing MAFLD. Results: Among the 361 PLWH, 141 were diagnosis with MAFLD, with a prevalence of 39.05%. Out of these 361 patients, 111 were overweight (BMI≥24kg/m 2 ), and 250 were non-overweight(BMI<24kg/m 2 ). MAFLD affect 58(23.2%) in 250 lean PLWH. Among the overall population, the NSS had the highest AUROC of 0.887, followed by FLI (AUROC =0.880), ZJU (AUROC = 0.873), LAP (AUROC = 0.849), and ST (AUROC = 0.847). ION had the lowest AUROC with value of 0.744. In the non-overweight population, the AUROC of NSS was 0.868, suggesting moderate diagnostic value. However, among overweight or obesity population, it showed limited diagnostic value with AUROC of 0.736. Conclusions: We found a non-negligible prevalence of MAFLD in lean PLWH. Models established on chemical and metabolic indicators provide no advantage for MAFLD diagnosis in PLWH, especially for overweight patients. PLWH should be prioritized for inclusion in global trials of MAFLD management.

757

Semaglutide Improves Steatohepatitis in People With HIV: The SLIM LIVER Study Jordan E. Lake 1 , Doug Kitch 2 , Amy Kantor 2 , Rebeca Mayo 3 , Pablo Belaunzarán Zamudio 4 , Carl Fichtenbaum 5 , Todd Brown 6 , Kathleen Corey 7 , Fred R. Sattler 8 , Kristine M. Erlandson 9 , for the ACTG A5371 Protocol Team 1 University of Texas Health Science Center at Houston, Houston, TX, USA, 2 Harvard TH Chan School of Public Health, Boston, MA, USA, 3 OWL Metabolomics, Derio, Spain, 4 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA, 5 University of Cincinnati Medical Center, Cincinnati, OH, USA, 6 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 7 Massachusetts General Hospital, Boston, MA, USA, 8 University of Southern California, Los Angeles, CA, USA, 9 University of Colorado Anschutz Medical Campus, Aurora, CO, USA Background: In general population adults with metabolic dysfunction associated steatotic liver disease (MASLD) and non-cirrhotic liver fibrosis, the glucagon-like peptide-1 receptor agonist semaglutide (SEMA) improves steatohepatitis (MASH) but not liver fibrosis. The OWLiver metabolomics algorithm is validated against liver biopsy in general population cohorts and uses serum profiling to distinguish MASLD from No MASLD. Among persons with MASLD, it can also distinguish MASH and MASH with significant fibrosis (at-risk MASH) from No MASH. We previously reported that 24 weeks (W) of SEMA reduced magnetic resonance imaging (MRI)-quantified liver fat in people with HIV (PWH) that correlated strongly with weight loss. Here we report metabolomic profiles before and after SEMA. Methods: In ACTG A5371, PWH >/= 18 years old on suppressive antiretroviral therapy (ART) with MRI-defined MASLD received SEMA 1mg sc weekly for 24 W. Of 51 participants, 36 US PWH with clinical response (>5 lb weight loss) to SEMA had serum analyzed by ultra-high performance liquid chromatography-mass spectrometry at OWL Metabolomics for OWLiver disease staging. Results: Participants had: median age 52 years, BMI 34 kg/m 2 , 39% Hispanic ethnicity, 28% Black/African American race, 45% cis/trans female and 77% INSTI-based ART. At W0, OWLiver defined 69% as MASLD without MASH, 22% MASH and 3% at-risk MASH. Two PWH were re-classified as No MASLD (does not exclude early steatosis). After 24 W of SEMA, 31% of PWH and MASLD improved their disease severity category: 11% MASLD without MASH to No MASLD, 6% MASH to No MASLD, 11% MASH to MASLD without MASH and 3% at-risk MASH to MASH. However, 61% had no change in disease category and 8% worsened (latter despite steatosis improvement on MRI): 1 MASLD without MASH to at-risk MASH, 1 MASLD without MASH to MASH and 1 No MASLD to MASLD without MASH (Table). Conclusions: Among PWH and MRI-defined MASLD, 24 W of low-dose SEMA led to significant improvement in MASLD disease severity in nearly 1/3 of participants and across all disease severity categories. While 61% did not change disease category, improvements within a category (such as from severe to mild MASLD) may have occurred. Studies of longer duration and higher dose SEMA for MASLD are needed to determine if additional benefit can be gained. Importantly, use of the OWLiver metabolomics algorithms provided evidence of improvement in predicted histology without a requirement for liver biopsy and should be considered for disease staging in PWH.

Poster Abstracts

759

Effects of Semaglutide on Gut Microbiota in People With HIV: The SLIM LIVER Study Stephanie M. Dillon 1 , Daniel N. Frank 1 , Charles E. Robertson 1 , Jennifer M. Kofonow 1 , Cara C. Wilson 1 , Alan Landay 2 , Todd Brown 3 , Fred R. Sattler 4 , Jordan E. Lake 5 , Kristine M. Erlandson 1 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 University of Texas Medical Branch, Galveston, TX, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 University of Southern California, Los Angeles, CA, USA, 5 University of Texas Health Science Center at Houston, Houston, TX, USA Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent comorbidity in people with HIV (PWH). Gut microbiota profiles such as lower diversity and/or alterations in microbiota community structure, have been variably associated with MASLD in people with and without HIV. Recent murine models of metabolic diseases, including MASLD,

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