Baseline Liver Metabolic Health in Newly Diagnosed People Living with HIV Compared with HIV-Negative Controls: Cross-Sectional Findings from the Prospective MASHIV-TR Cohort

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important comorbidity in people living with HIV (PLWH), yet most data derive from individuals receiving antiretroviral therapy (ART). In the baseline cross-sectional analysis of the prospective multicentre MASHIV-TR cohort (nine centres, Türkiye), we compared 250 newly diagnosed, ART-naïve PLWH and 161 HIV-negative controls. Hepatic steatosis and liver stiffness were assessed by vibration-controlled transient elastography; MASLD was defined as hepatic steatosis, indicated by CAP ≥ 248 dB/m together with at least one cardiometabolic risk factor. MASLD prevalence was similar in the two groups (25.2% vs. 30.4%; p = 0.245), and HIV status was not independently associated with CAP in PLWH (+10.69 dB/m per 50 mg/dL) or in controls (+9.26 dB/m), whereas CD4 and CD8 counts, the CD4/CD8 ratio and HIV-RNA were not associated with the liver outcome. Before ART, hepatic steatosis tracked metabolic rather than HIV-specific markers.