Poor sleep and hepatic steatosis contribute to poorer quality of life in people with human immunodeficiency virus

BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) and poor sleep are common among people with human immunodeficiency virus (PWH) and may mediate the impaired health-related quality of life (HRQoL) seen in PWH and in people with MASLD. However, the prevalence and burden of poor sleep in PWH and MASLD is not well described. AIM To study the prevalence and multi-faceted relationship between MASLD, poor sleep, and HRQoL in PWH. METHODS In this cross-sectional, observational study, adult PWH and no other known cause of liver disease underwent controlled attenuated parameter (for hepatic fat) and liver stiffness measurement via vibration-controlled transient elastography at eight United States. centers (July 2021 to November 2024). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) and HRQoL by Rand 36-Item Short Form Health Survey. Outcomes were compared using standard methods. Multivariate regression examined associations between sleep quality, HRQoL, and clinical factors. RESULTS PWH (n = 1005) on suppressive antiretroviral therapy had mean age 55 years and were 65% non-White and 27% cisgender female; 77% had body mass index (BMI) > 25 kg/m², 44% had MASLD (controlled attenuated parameter ≥ 263 dB/minute), 13% liver fibrosis (liver stiffness measurement ≥ 8 kPa) and 64% poor sleep quality (PSQI > 5). The mean ± SD of PSQI was 6.6 ± 4.1, with no differences by MASLD status; MASLD + fibrosis was associated with poorer sleep. HRQoL was low (< 50) overall: A step-wise decline in physical component summary (PCS) scores was associated with worse liver disease, from no MASLD to MASLD + fibrosis. Among poor sleepers, a similar step-wise PCS worsening occurred. In multivariate analysis, MASLD + fibrosis was associated with lower PCS and poor sleep was associated with worse physical and mental HRQoL. CONCLUSION In this cohort of PWH, there was no association between MASLD and sleep quality. Poor sleep, MASLD and liver fibrosis were independently associated with poor HRQoL.