Lipid Profile Differences in HIV‐Infected Populations With Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Systematic Review and Meta‐Analysis

ABSTRACT Introduction Advances in HIV management have transformed HIV into a chronic condition, resulting in improved prognosis and increased survival among people living with HIV (PLWH). Traditional risk factors for metabolic dysfunction‐associated steatotic liver disease (MASLD)—including dyslipidemia—are prevalent in PLWH. This systematic review and meta‐analysis aim to synthesize current evidence on lipid profile disturbances as contributors to MASLD in PLWH. Methods This systematic review and meta‐analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and registered in PROSPERO with registration number CRD420251054477. We searched seven databases to identify studies reporting the prevalence and characteristics of MASLD in PLWH. Meta‐analysis was conducted using Review Manager 5.4.1. Mean differences (MDs) were calculated using a random‐effects model. Risk of bias was assessed using the ROBINS‐E tool. Results A total of 17 studies comprising 3933 HIV‐positive participants were included, among whom 1226 (37%) had MASLD. Male sex was significantly associated with MASLD (OR = 1.57; 95% CI: 1.13–2.17; p = 0.007). MASLD was significantly associated with higher body mass index (BMI) (MD = 3.23 kg/m²; p < 0.00001). Lipid profile analysis revealed that MASLD patients had higher total cholesterol (MD = 6.62 mg/dL; p = 0.01), low density lipoprotein (LDL) (MD = 3.83 mg/dL; p = 0.01), triglycerides (MD = 63.02 mg/dL; p < 0.00001), and lower high density lipoprotein (HDL) (MD = −3.73 mg/dL; p < 0.0001). Conclusion This study demonstrates a significant difference in lipid profiles (higher total cholesterol, LDL, triglycerides, and lower HDL) among PLWH who develop MASLD, suggesting a potential metabolic signature associated with this comorbidity.