Metabolic Issues More Common in Patients With HIV

A higher burden of metabolic issues were found in people living with HIV in a study published in HIV Research & Clinical Practice.¹ Despite this increased burden, however, individuals living with HIV were not more metabolically ill compared with the general population.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in those living with HIV compared with others, as those living with HIV are at an increased risk of other health complications, including liver problems caused by HIV medications.² The severity of MASLD could also be increased in this population, as those living with HIV have more severe liver fibrosis and use antiretroviral therapy (ART), which can leave them more vulnerable to other diagnoses. This study aimed to compare metabolic syndrome components and MASLD parameters between people not living with HIV and those living with HIV and using ART.

This study used a case-control design to perform the analysis, including those aged 18 to 65 years with an HIV infection treated for at least 2 years; participants could not have either hepatitis B or hepatitis C. Individuals with uncontrolled endocrine disorders, chronic liver disease, complications of liver disease, malignant tumors, who were pregnant, or who had type 1 diabetes were excluded from the study. Individuals who had a visit to the clinic between April and October of 2021 were invited to participate in the study.

Participants had their blood drawn for testing, and all participants completed a survey to assess weight, height, alcohol consumption, chronic diseases, medications, and use of drugs and tobacco.

There were 60 participants with HIV and 30 controls included in the study. A total of 34 participants with HIV were treated with integrase strand transfer inhibitors and tenofovir alafenamide as their primary form of ART. The patients had a mean (SD) treatment time of 6.94 (3.83) years, and all but 1 had an undetectable viral load.

Dyslipidemia was higher in HIV patients (68.33% vs 40%) when compared with the control group. FIB-4, NFS, MACK-3, NAFLD-LFS, Forns, and TyG were all higher in people living with HIV, but their values did not meet the cut-off values to define the risk of steatosis or fibrosis. There was a significant difference between the study group and controls in NAFLD, with 58 participants in the study group and 26 in the control group exceeding the cut-off point of –0.67. People living with HIV had significantly lower adiponectin levels compared with HIV (median, 6.82 vs 8.29 mcg/ml). CK-18 level was also higher in individuals living with HIV (median, 1095 vs 580 pg/ml).

Metabolic syndrome was found in 13.33% of those living with HIV.

The relatively healthy control group was a limitation of this study, as none of the control participants reported smoking. This could have limited generalizability overall. The groups of controls and the HIV participants were small, and the case-control design could have introduced selection bias. The participants were selected during the COVID-19 pandemic, which could have affected the willingness of some patients to participate. Body mass index was not matched in the case and control groups.

Although those with HIV and using ART had worse lipid, carbohydrate, and MASLD parameters compared with the healthy controls, the authors concluded that “the results [they] obtained cannot definitively classify this people living with HIV group as more metabolically ill than the general population.” They encouraged more research involving larger groups to clarify their results.

References

1. Bialy M, Czarnecki M, Inglot M. Liver metabolic health and the components of metabolic syndrome in people living with HIV – do they differ from those in a ‘healthy’ population? HIV Res Clin Pract. 2025;26(1):2555065. doi:10.1080/25787489.2025.2555065

2. HIV and hepatoxicity. HIVinfo. Updated October 18, 2024. Accessed September 16, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-hepatotoxicity