Predictors of Incident Hepatic Fibrosis and Steatotic Liver Disease–Associated Fibrosis Among Women with and without HIV

Abstract Background Liver fibrosis is an important cause of non-AIDS morbidity among women with HIV (WWH), but predictors of incident fibrosis in the absence of viral hepatitis are not well defined. Methods We included women with and without HIV enrolled in the Women’s Interagency HIV Study (WIHS), now part of the MACS/WIHS Combined Cohort Study, who underwent vibration-controlled transient elastography (VCTE) between 2013 and 2020 as part of the Liver Disease and Reproductive Aging (LIVRA) Study and had at least two VCTE exams. Participants with viral hepatitis, heavy alcohol use, or baseline fibrosis were excluded. Poisson regression estimated incidence rate ratios (IRRs) for incident fibrosis, defined as liver stiffness ≥7.1 kPa. Models included time-updated covariates and tested interactions between HIV and steatosis measured by controlled attenuation parameter (CAP). Results Among 1,036 women (709 WWH, 327 without HIV), median age was 49 years and median BMI 32 kg/m2. Over a mean follow-up of 3.5 years, 19% developed incident fibrosis. HIV infection (IRR 1.72, 95% CI 1.12–2.65) and higher CAP (per 10 dB/m; IRR 1.04, 95% CI 1.00–1.08) were associated with fibrosis in multivariable adjusted models. The association between CAP and fibrosis differed by HIV status (interaction p = 0.02) and was attenuated among WWH. Fibrosis without steatosis accounted for 28% of new fibrosis in WWH and was more common in those with prior AIDS. Conclusions HIV infection predicted incident hepatic fibrosis, while steatosis was a weaker predictor in WWH. Fibrosis without steatosis was common, suggesting distinct fibrosis phenotypes and potential HIV-specific pathways of liver injury.