Simple Adiposity Measures Discriminate MASLD by Transient Elastography in People with HIV: Results from a US Multicenter Cohort

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ID: 339190
2026
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Abstract
ABSTRACT Background 40% of people with HIV (PWH) have metabolic dysfunction-associated steatotic liver disease (MASLD), but simple clinical tools for risk stratification do not exist. We evaluated whether adiposity indices are associated with MASLD in PWH and whether performance varies by race or ethnicity. Methods We examined PWH from a prospective, cross-sectional study conducted by the NIDDK-funded HIV NASH CRN. Participants had suppressed HIV-1 RNA and underwent vibration controlled transient elastography and anthropometric measurements. The primary outcome was MASLD, defined as controlled attenuation parameter (CAP) ≥263 dB/m with ≥1 cardiometabolic risk factor without heavy alcohol use or viral hepatitis. Adiposity indices included waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), body roundness index (BRI), relative fat mass (RFM), visceral adiposity index (VAI), and waist-to-hip ratio (WHR). Results Among 990 PWH, 445 (44.9%) had MASLD. All adiposity indices were strongly associated with MASLD (p<0.001). Several adiposity indices had good discrimination for MASLD in the overall cohort, including WC (AUC 0.79, 95% CI 0.76-0.81), WHtR (0.77 [0.74-0.80]), BRI (0.77 [0.74-0.80]), and BMI (0.75 [0.72-0.78]). WC, RFM, WHtR, and BRI had significant interactions with race (interaction p<0.05). Adiposity indices overall performed better in Black and Hispanic PWH compared to White PWH. Conclusions In PWH, adiposity indices were strongly associated with MASLD, though their discriminatory ability varied by race and ethnicity. Simple anthropometric indices may provide practical tools for MASLD risk assessment that could be tailored by race and ethnicity.
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Authors Kara Wegermann, Laura Wilson, Eduardo Vilar Gomez, Holly Crandall, Jennifer C. Price, Richard K. Sterling, Sonya L. Heath, Mark Sulkowski, Rohit Seth Loomba, Susanna Naggie, Naga Chalasani, Jordan E. Lake
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag729
URL
https://doi.org/10.1093/ofid/ofag729
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