Metabolic Dysfunction–Associated Steatotic Liver Disease Is Associated With Impaired Health-Related Quality of Life in People With HIV

IF 3.3

Gastro hep advances Pub Date : 2026-01-01 Epub Date: 2026-04-15 DOI:10.1016/j.gastha.2026.100966

Felice Cinque , Michael Nudo , Sahar Saeed , Jihoon Lim , Dana Kablawi , Gabrielle Mariano , Amanda Lupu , Wesal Elgretli , Erica E.M. Moodie , Colleen Price , Ken Monteith , Curtis Cooper , Sharon Walmsley , Nadine Kronfli , Joseph Cox , Cecilia Costiniuk , Alexandra De Pokomandy , Jean-Pierre Routy , Marina B. Klein , Bertrand Lebouche , Giada Sebastiani

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Abstract

Background and Aims

Metabolic dysfunction–associated steatotic liver disease (MASLD) is common in people with HIV (PWH), yet its impact on health-related quality of life (HRQoL) remains poorly characterized. We evaluated the association between MASLD and both generic and liver-specific HRQoL.

Methods

We conducted a cross-sectional analysis within a national multicenter cohort of PWH. MASLD was defined as hepatic steatosis (controlled attenuation parameter >248 dB/m) plus at least metabolic comorbidity and significant liver fibrosis as liver stiffness measurement ≥8 kPa on FibroScan. Generic HRQoL was assessed using the Short Form-36 and liver-specific HRQoL using the Chronic Liver Disease Questionnaire (CLDQ). Adjusted estimated mean differences were estimated using multivariable linear regression.

Results

Among 519 participants, the prevalence of MASLD and significant liver fibrosis was 41.4% and 7.2%, respectively. MASLD was independently associated with lower generic HRQoL, including reduction of physical functioning (−4.6; 95% confidence interval [CI] −9.12 to −0.01) and general health (−4.5; 95% CI −8.58 to −0.48) on the Short Form-36. Liver-specific HRQoL was more affected; MASLD was associated with a lower overall CLDQ score (−0.29; 95% CI −0.49 to −0.09), driven by worse fatigue, systemic symptoms, emotional symptoms, and worry. Among PWH with MASLD, increasing metabolic comorbidity burden was associated with a dose–response decline in physical HRQoL, whereas liver-specific HRQoL did not differ across comorbidity strata. Significant fibrosis was associated with lower CLDQ activity (−0.62; 95% CI −1.20 to −0.05) and worry (−0.60; 95% CI −1.15 to −0.05).

Conclusion

In PWH, MASLD is associated with impaired HRQoL, particularly fatigue, systemic symptoms, and emotional well-being. Greater metabolic burden and liver fibrosis further worsen patient-reported outcomes.

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代谢功能障碍相关脂肪变性肝病与HIV感染者健康相关生活质量受损相关

背景和目的代谢功能障碍相关的脂肪变性肝病（MASLD）在HIV感染者（PWH）中很常见，但其对健康相关生活质量（HRQoL）的影响仍缺乏明确的特征。我们评估了MASLD与通用和肝脏特异性HRQoL之间的关系。方法：我们在全国多中心的PWH队列中进行了横断面分析。MASLD定义为肝脂肪变性（控制衰减参数>；248 dB/m）加上至少代谢合并症和显著的肝纤维化（在FibroScan上肝脏硬度测量≥8 kPa）。通用HRQoL采用Short -36表评估，肝脏特异性HRQoL采用慢性肝病问卷（CLDQ）评估。使用多变量线性回归估计调整后的估计平均差异。结果在519名参与者中，MASLD和显著肝纤维化的患病率分别为41.4%和7.2%。MASLD与较低的一般HRQoL独立相关，包括Short -36中身体功能（- 4.6,95%可信区间[CI] - 9.12至- 0.01）和一般健康（- 4.5,95% CI - 8.58至- 0.48）的降低。肝脏特异性HRQoL受影响较大；MASLD与较低的总体CLDQ评分相关（- 0.29;95% CI - 0.49至- 0.09），由更严重的疲劳、全身症状、情绪症状和担忧驱动。在合并MASLD的PWH中，代谢合并症负担的增加与物理HRQoL的剂量反应下降有关，而肝脏特异性HRQoL在合并症层之间没有差异。显著纤维化与较低的CLDQ活性（- 0.62;95% CI - 1.20至- 0.05）和焦虑（- 0.60;95% CI - 1.15至- 0.05）相关。结论：在PWH中，MASLD与HRQoL受损有关，特别是疲劳、全身症状和情绪健康。更大的代谢负担和肝纤维化进一步恶化了患者报告的结果。

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