S2770 Statin Use in Patients With HIV and MASLD: A Global Cohort Study

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with HIV (PWH). The etiology is believed to be multifactorial and comprises metabolic risk factors, chronic inflammation from HIV infectivity, and antiretroviral therapy (ART). MASLD is a known independent risk factor for cardiovascular disease (CVD) and major adverse cardiovascular events (MACE), and MASLD is significant cause of mortality. While guidelines for statin therapy are established for PWH to reduce atherosclerotic CVD risk, the specific safety and efficacy of statin use in PWH with co-occurring MASLD remain largely unexamined in dedicated studies. Methods: We conducted a retrospective cohort study using medical records for patients with HIV and MASLD and categorized cohorts with patients who were on statin therapy (N = 2362) and not on statin therapy (N = 2362). The primary composite outcome of our investigation was liver-related events: ascites, hepatic encephalopathy, hepatorenal syndrome, esophageal varices, spontaneous bacterial peritonitis and variceal bleeding. Secondary outcomes included all-cause mortality and major adverse cardiovascular events: acute myocardial infarction (MI), cerebrovascular accident (CVA), and heart failure exacerbations. Risk assessments were conducted using odds ratios (OR). Results: Statin use was associated with reduced risk of several severe liver-related adverse events in patients with HIV and MASLD: ascites (OR = 0.39, 95% CI 0.30-0.50, P < 0.001), variceal bleeding (OR = 0.55, 95% CI 0.40-0.75, P < 0.001), hepatic encephalopathy (OR = 0.39, 95% CI 0.21-0.74, P < 0.001), SBP (OR = 0.43, 95% CI 0.21-0.91, P = 0.023), malnutrition (OR = 0.53, 95% CI 0.40-0.71, P < 0.001), mortality (OR = 0.49, 95% CI 0.40-0.60, P < 0.001), and hospitalizations (OR = 0.78%, CI 0.69-0.86, P < 0.001). No statistically significant association was observed with the development of hepatorenal syndrome (HRS) (OR = 0.55, 95% CI 0.26-1.20, P = 0.129) or heart failure exacerbations (OR = 1.00, 95% CI 0.75-1.33, P = 1.000). Alternatively, statin use was associated with increased odds of acute MI (OR = 1.70; 95% CI 1.20-2.30, P = 0.001) and CVA (OR = 2.03, 95% CI 1.50-2.75, P < 0.001). Conclusion: In patients with HIV and MASLD, statin therapy may be associated with a lower risk of liver-related complications and reduced all-cause mortality. These findings suggest potential benefits of statin therapy for patients with MASLD and HIV, further highlighting the need for further investigation in prospective trials.