{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:08:56Z","timestamp":1791486536730,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002873","name":"Chulalongkorn University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002873","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012527","name":"Office of the Higher Education Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012527","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>A change in terminology from fatty liver disease to metabolic\u2010associated fatty liver disease (MAFLD), along with modified diagnostic criteria, was proposed in 2020, and data regarding MAFLD burden in people living with HIV are limited. We investigated associations between MAFLD and immune activation, cardiovascular disease (CVD) risks including epicardial fat volume, and steatohepatitis in an Asian cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated CVD risk (epicardial fat tissue, coronary artery calcium [CAC] score, and 10\u2010year atherosclerotic CVD [ASCVD] score) in people living with HIV aged &gt;50\u2009years. Individuals with excessive alcohol consumption and viral hepatitis infections were excluded. MAFLD diagnosis was based on 2020 International Consensus criteria. Non\u2010alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis was defined as FibroScan\u2010aspartate aminotransferase (FAST) score \u22650.67 and &gt;0.35. Multivariate logistic regression models were used to investigate factors associated with MAFLD and NASH with significant activity and liver fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age was 54\u2009years (interquartile range [IQR] 52\u201360) and current CD4 count was 613 (IQR 467\u2013804) cells\/mm<jats:sup>3<\/jats:sup>. A total of 37% were female, and most (98%) people living with HIV were virally suppressed. The prevalence of MAFLD and non\u2010alcoholic fatty liver disease was 35% and 38%, respectively. In multivariate analyses, higher body mass index, albumin, epicardial fat volume, and liver stiffness were significantly associated with MAFLD. A higher CD4\/CD8 ratio was associated with a lower risk of MAFLD. People with HIV with MAFLD had higher odds of having NASH with significant activity and liver fibrosis (adjusted odds ratio 3.3; 95% confidence interval 1.6\u20136.6), and similar associations were also observed among different MAFLD categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The complex relationship between MAFLD and immune activation, steatohepatitis, and epicardial fat tissue suggests an increased risk of advanced liver disease and CVDs beyond the traditional risk factors in people living with HIV with fatty liver disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13499","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T08:06:55Z","timestamp":1683792415000},"page":"1000-1012","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Metabolic\u2010Associated Fatty Liver Disease (<scp>MAFLD<\/scp>) is associated with immune activation, increased epicardial fat volume, and steatohepatitis among people with <scp>HIV<\/scp> in a Thai cohort"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3731-7960","authenticated-orcid":false,"given":"Win Min","family":"Han","sequence":"first","affiliation":[{"name":"HIV\u2010NAT, Thai Red Cross AIDS Research Centre  Bangkok Thailand"},{"name":"The Kirby Institute, University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanakorn","family":"Apornpong","sequence":"additional","affiliation":[{"name":"HIV\u2010NAT, Thai Red Cross AIDS Research Centre  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pairoj","family":"Chattranukulchai","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Faculty of Medicine Chulalongkorn University, King Chulalongkorn Memorial Hospital  Bangkok 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Excellence Centre, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pisit","family":"Tangkijvanich","sequence":"additional","affiliation":[{"name":"Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anchalee","family":"Avihingsanon","sequence":"additional","affiliation":[{"name":"HIV\u2010NAT, Thai Red Cross AIDS Research Centre  Bangkok Thailand"},{"name":"Center of Excellence in Tuberculosis Faculty of Medicine Chulalongkorn University  Bangkok 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