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Background <p>This study aimed to investigate the prevalence of lean metabolic dysfunction-associated fatty liver disease (lean MAFLD) in people living with HIV (PLWH) and to evaluate the performance of ten diagnostic models in identifying MAFLD in this population.</p> Methods <p>Lean MAFLD was defined as MAFLD occurring in patients with a body mass index (BMI) &lt; 24&#xa0;kg/m². Ten models, including fatty liver index (FLI), non-alcoholic fatty liver disease-liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), Simple Index (SI), index of non-alcoholic fatty liver disease (ION), ZJU index, non-alcoholic fatty liver screening score (NSS), K-non-alcoholic fatty liver disease (K-NAFLD), visceral adiposity index (VAI), and lipid accumulation product (LAP), were evaluated for their ability to diagnose MAFLD. The diagnostic performance of these models was assessed using the area under the receiver operating characteristic curve (AUROC).</p> Results <p>Among the 361 PLWH, 141 were diagnosed with MAFLD, resulting in a prevalence of 39.06%. MAFLD affected 58 (23.20%) of the 250 lean PLWH. For lean PLWH, the results generally matched those of the overall population. The NSS had the highest AUROC of 0.87, followed by the FLI (AUROC = 0.86), ZJU (AUROC = 0.85), and LAP (AUROC = 0.85). There was no statistically significant difference in diagnostic efficacy between NSS and these three indicators. The NSS performed significantly better than VAI, SI, NAFLD-LFS, K-NAFLD, ION, and HSI, with AUROC values of 0.80, 0.80, 0.80, 0.79, 0.79, and 0.77, respectively (all <i>p</i> &lt; 0.05). Interestingly, for PLWH who are overweight, the diagnostic value of these models was low, ranging from 0.64 to 0.77. The FLI achieved a higher AUROC of 0.77, while the ION had the lowest value of 0.64.</p> Conclusion <p>Our study found a significant prevalence of MAFLD among lean PLWH. While general population-based diagnostic models show moderate accuracy in diagnosing MAFLD in this subgroup, they perform poorly in overweight PLWH, indicating the need for more specialized approaches.</p> Trial registration <p>This study was registered with the U.S. National Library of Medicine’s ClinicalTrials.gov platform under the code NCT04215926 on December 29, 2019.</p>

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Evaluation of ten diagnostic models for metabolic dysfunction-associated fatty liver disease in lean people living with HIV

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月26日

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  • Wei Xu,
  • Danping Liu,
  • Renfang Zhang,
  • Jun Chen,
  • Yinzhong Shen

摘要

Background

This study aimed to investigate the prevalence of lean metabolic dysfunction-associated fatty liver disease (lean MAFLD) in people living with HIV (PLWH) and to evaluate the performance of ten diagnostic models in identifying MAFLD in this population.

Methods

Lean MAFLD was defined as MAFLD occurring in patients with a body mass index (BMI) < 24 kg/m². Ten models, including fatty liver index (FLI), non-alcoholic fatty liver disease-liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), Simple Index (SI), index of non-alcoholic fatty liver disease (ION), ZJU index, non-alcoholic fatty liver screening score (NSS), K-non-alcoholic fatty liver disease (K-NAFLD), visceral adiposity index (VAI), and lipid accumulation product (LAP), were evaluated for their ability to diagnose MAFLD. The diagnostic performance of these models was assessed using the area under the receiver operating characteristic curve (AUROC).

Results

Among the 361 PLWH, 141 were diagnosed with MAFLD, resulting in a prevalence of 39.06%. MAFLD affected 58 (23.20%) of the 250 lean PLWH. For lean PLWH, the results generally matched those of the overall population. The NSS had the highest AUROC of 0.87, followed by the FLI (AUROC = 0.86), ZJU (AUROC = 0.85), and LAP (AUROC = 0.85). There was no statistically significant difference in diagnostic efficacy between NSS and these three indicators. The NSS performed significantly better than VAI, SI, NAFLD-LFS, K-NAFLD, ION, and HSI, with AUROC values of 0.80, 0.80, 0.80, 0.79, 0.79, and 0.77, respectively (all p < 0.05). Interestingly, for PLWH who are overweight, the diagnostic value of these models was low, ranging from 0.64 to 0.77. The FLI achieved a higher AUROC of 0.77, while the ION had the lowest value of 0.64.

Conclusion

Our study found a significant prevalence of MAFLD among lean PLWH. While general population-based diagnostic models show moderate accuracy in diagnosing MAFLD in this subgroup, they perform poorly in overweight PLWH, indicating the need for more specialized approaches.

Trial registration

This study was registered with the U.S. National Library of Medicine’s ClinicalTrials.gov platform under the code NCT04215926 on December 29, 2019.