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We assessed predictors of liver steatosis progression over 36 months in PLWH from low\u2010 and middle\u2010income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2020 and 2023, we enrolled PLWH aged \u226540 years who had been on antiretroviral therapy (ART) for \u22656 months at nine HIV clinics in the IeDEA Sentinel Research Network (SRN) across the Asia\u2010Pacific, the Americas and African IeDEA regions, and followed them prospectively for 36 months. Participants with available and reliable controlled attenuation parameter (CAP) measurements at both enrolment and the 36\u2010month visits were included in the analysis. Steatosis progression was defined as incident steatosis (CAP \u2265248 dB\/m) or a transition to a higher steatosis grade (moderate \u2265268 dB\/m; severe \u2265280 dB\/m) among those with a lower steatosis grade at enrolment. Logistic regression was used to assess predictors of progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 923 participants (63% female; median age 50 years, interquartile range 45\u201355) in this analysis. At enrolment, 51% were overweight or obese, 10% had type 2 diabetes mellitus (T2DM), 94% had HIV RNA &lt;1000 copies\/mL and 72% were on integrase strand inhibitor (INSTI)\u2010based ART. During the 36\u2010month follow\u2010up, 190 (20%) participants showed steatosis progression, including 147 (74%) with incident steatosis and 49 (26%) with worsening of steatosis grades. The progression rate was significantly higher in Asia\u2010Pacific (33% [95% CI, 24\u221244]) and the Americas (36% [95% CI, 26\u221246]) compared to the African regions (17% [95% CI, 14\u221220]). Independent predictors of steatosis progression were overweight\/obesity (aOR: 2.97, 95% CI: 2.03\u22124.40), T2DM (aOR: 2.41, 95% CI: 1.45\u22123.96) and dyslipidaemia (aOR: 1.46, 95% CI: 1.01\u22122.12). In females, INSTI use for \u22652 years at enrolment was additionally associated (aOR 3.19, 95% CI: 1.35\u22128.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Metabolic disorders\u2014including T2DM, overweight\/obesity and dyslipidaemia\u2014were associated with steatosis progression in PLWH in our cohort. These findings underscore the need for targeted monitoring and prevention strategies to address this significant public health issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70184","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:01:07Z","timestamp":1790697667000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Liver Steatosis Progression Among People Living With HIV in Low\u2010 and Middle\u2010Income Countries: A Multicentre Longitudinal Study"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0446-1827","authenticated-orcid":false,"given":"Marie K.","family":"Plaisy","sequence":"first","affiliation":[{"name":"Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre Bordeaux 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