CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

762

Determinants of Steatotic Liver Disease Among People With HIV in Europe and Australia Carlotta Riebensahm 1 , Wendy Bannister 2 , Josep M. Llibre 3 , Gilles Wandeler 4 , Lars Peters 5 , for the RESPOND Study Group 1 University Hospital Bern, Bern, Switzerland, 2 University of Copenhagen, Copenhagen, Denmark, 3 Hospital Germans Trias i Pujol, Barcelona, Spain, 4 Bern University Hospital, Bern, Switzerland, 5 Centre of Excellence for Health, Immunity and Infections, Copenhagen, Denmark Background: Given the increased prevalence of steatotic liver disease (SLD) in people with HIV, understanding its natural course and progression to liver fibrosis is crucial for guiding clinical management. Methods: We assessed SLD and liver fibrosis in RESPOND participants from January 2012 to December 2022 using serological scores validated for people with HIV, excluding those with viral hepatitis and pregnant women. The Hepatic Steatosis Index (HSI) was calculated using gender, BMI, AST, ALT, and diabetes, and the Fibrosis-4 (FIB-4) Index using age, AST, ALT, and platelet count. Presumed SLD was indicated by a HSI of ≥36 as pre-established, and liver fibrosis by two consecutive FIB-4 scores of ≥3.25. We used multivariable logistic regression to evaluate factors associated with HSI ≥36 at first assessment. Incidence rates (IRs) of HSI ≥36 were calculated for participants with an initial HSI <36, and IRs of two consecutive FIB-4 ≥3.25 for those with HSI ≥36. Results: Among 16,327 eligible participants, median age was 45 years (interquartile range [IQR] 36-53), with 3,935 (24.1%) being female, and 11,438 (70.1%) white. Median CD4+ count was 549cells/μl (IQR 379-741), 6,473 (39.6%) had a BMI ≥25kg/m², and 841 (5.2%) diabetes. The prevalence of HSI ≥36 at the first measurement was 31.9%, with 1.2% showing two consecutive FIB-4 ≥3.25. In multivariable analyses, the odds of having an HSI ≥36 increased with age up to 60 years and higher CD4 counts (Figure 1). Black participants had higher odds (adjusted odds ratio [aOR] 1.42; 95% CI 1.27–1.60) and Asian participants lower odds (aOR 0.56, 95% CI 0.44-0.72) compared to white. Hypertension (aOR 1.92, 95% CI 1.78–2.07), dyslipidemia (aOR 1.59, 95% CI 1.45–1.73), and current use of integrase strand inhibitors (InSTI) (aOR 1.22, 95% CI 1.05-1.41, vs. non-nucleoside reverse transcriptase inhibitors) were associated with higher odds of HSI ≥36. Among 11,114 participants with HSI <36 at first assessment, the median follow-up was 8 years (IQR 4.3-10.1), with a 6-months interval (IQR 4.3-8.1) between assessments. During 63,161 person-years of follow-up (PYFU), the IR for HSI ≥36 was 13.3 per 100 PYFU (95% CI 13.1-13.6). For those with HSI ≥36, the IR of subsequently having two consecutive FIB-4 ≥3.25 was 0.5 per 100 PYFU (95% CI 0.5-0.6). Conclusions: Participants aged 50-59 years, black participants, and those with higher CD4 counts, metabolic comorbidities, or exposure to InSTI were more likely to have HSI ≥36. The progression to liver fibrosis was rare.

763

Diabetes Mellitus and Liver Disease Progression in PWH With Metabolic Dysfunction Associated SLD Win Min Han 1 , Tanakorn Apornpong 2 , Natthaya Chuaypen 3 , Thin Phyu Phyu Aung 4 , Hein Minn Kyaw 2 , Porntep Amornritvanich 5 , Napon Hiranburana 2 , Hay Mar Su Lwin 2 , Akarin Hiransuthikul 3 , Stephen Kerr 3 , Pisit Tangkijvanich 3 , Anchalee Avihingsanon 6 , for the HIV-NAT 006 Study Team 1 Kirby Institute, Sydney, Australia, 2 HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand, 3 Chulalongkorn University, Bangkok, Thailand, 4 Harlem Hospital Center, New York, NY, USA, 5 Police General Hospital, Bangkok, Thailand, 6 HIV-NAT, Thai Red Cross AIDS and Infectious Disease Research Centre, Bangkok, Thailand Background: We investigated the risk of liver stiffness progression and advanced liver fibrosis (LF) by diabetes mellitus (DM) status among people with HIV (PWH) and metabolic-dysfunction associated stetotic liver disease (MASLD). Methods: PWH who had MASLD at their first vibration-controlled transient elastography or VCTE with both liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) available (defined as baseline) and had >1 LSM over follow-up were included. MASLD was defined as the presence of liver steatosis (CAP ≥248 dB/m) with at least one cardiometabolic condition. Change in LSM from baseline (ΔLSM) was evaluated using a linear mixed-effects model, adjusting for age, sex, duration since DM diagnosis, body mass index (BMI), ALT and AST all fixed at baseline, time since first VCTE and time-varying exposure to INSTIs. An interaction term between time and baseline DM was included to assess the effect of DM on ΔLSM. Multivariable Poisson regression was used to evaluate the association between baseline DM and the incidence of LF (defined as LSM ≥8kPa). Results: Among 345 PWH with MASLD included (35% female), median age was 48 (IQR, 43-54) years, median BMI was 25 (23-28) kg/m 2 and median CD4 was 662 (500-826) cells/ µ L at baseline. 94% had HIV RNA <50 copies/mL and median antiretroviral therapy (ART) duration was 15 (7-18) years. Ninety-seven (28%) had DM at baseline, with a median DM duration of 16 (13-18) years. PWH with DM at baseline had higher FIB-4 (0.92 [0.69-1.26] vs. 0.76 [0.59-1.01]) and LSM (6.6 [5.4-8.2] vs. 5.5 [4.6-7.2] kPa). The median duration between the first and last VCTE measurements was 47 (42-61) months. In adjusted analysis, LSM declined over time with an average of -0.15 kPa/year (95%CI -0.28, -0.01, p=0.035). The ΔLSM over time was not associated with baseline DM (P-interaction=0.40). However, among 260 PWH-MASLD without LF at baseline, the risk of LF (incidence rate 3.7 [2.6-5.2]/100 person-years) was more than three times higher in those with baseline DM (adjusted incidence risk ratio [aIRR]: 3.35, 95%CI 1.67-6.75, P=0.001). There was no strong evidence suggesting the association between baseline DM and advanced LF risk differed by INSTI exposure (P-interaction=0.54). Conclusions: Despite small decreases in LSM during follow-up, PWH with both MASLD and DM have a significantly higher risk of liver fibrosis. Prioritizing this population for treatments interventions may help mitigate liver disease progression.

Poster Abstracts

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