BACKGROUND: Hepatic steatosis, including non-alcoholic fatty liver disease (NAFLD), is common among people with HIV (PWH). We present baseline steatosis prevalence and cardiometabolic characteristics among REPRIEVE substudy participants.

METHODS: REPRIEVE is an international, primary cardiovascular disease prevention, randomized, controlled trial of pitavastatin calcium vs. placebo among 7,769 PWH ages 40-75 years on antiretroviral therapy (ART) and with low-to-moderate cardiovascular risk. A subset of participants underwent non-contrast computed tomography, with hepatic steatosis defined as mean hepatic attenuation <40 HU or liver/spleen ratio <1.0, and NAFLD defined as steatosis in the absence of frequent alcohol use or viral hepatitis.

RESULTS: Of 687 evaluable persons, median age was 51 years, BMI 27 kg/m2, CD4+ T cell count 607 cells/mm3; 17% natal female sex, 36% Black, 24% Hispanic, and 98% HIV-1 RNA <400 copies/mL. Hepatic steatosis prevalence was 22% (149/687), and NAFLD 21% (96/466). Steatosis/NAFLD prevalence was higher in males and with older age, non-Black race, and higher BMI and waist circumference. Both were associated with BMI >30 kg/m2, Metabolic Syndrome components, higher ASCVD risk score, HOMA-IR, LpPLA-2 and hs-CRP, and lower high-density lipoprotein cholesterol. Of HIV-/ART-specific characteristics, only history of an AIDS-defining illness was more common among persons with steatosis/NAFLD. After adjusting for age, sex and race/ethnicity, BMI >30 kg/m2, HOMA-IR >2.0, Metabolic Syndrome and each of its components were associated with NAFLD prevalence.

CONCLUSIONS: In this cohort with controlled HIV and low-to-moderate cardiovascular risk, hepatic steatosis and NAFLD were common and associated with clinically relevant metabolic and inflammatory disturbances, but not current HIV- or ART-related factors.