Dana Kablawi

INTRODUCTION The advent of effective antiretroviral therapy (ART) has transformed HIV infection from a life-threatening condition to a chronic disease with manageable outcomes [1]. However, this prolonged lifespan has unveiled a spectrum of non-communicable comorbidities, among which metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant concern [2]. MASLD is the most frequent chronic liver disease globally, affecting 32% of the general adult population [3, 4].

ALT alanine-aminotransferase ART antiretroviral therapy AST aspartate-aminotransferase BMI body mass index CAP controlled attenuation parameter CI confidence intervals HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HDL high-density lipoprotein cholesterol HIV human immunodeficiency virus HR hazard ratio IDU injecting drug user IU international units LIVEHIV LIVEr in HIV IQR interquartile range LSM liver stiffness measurement MASLD metabolic dysfunction-associated...

We may encounter slower recruitment rate or higher loss to follow-up than expected. In this case, we will consider including 1–2 other HIV care centres through our close link to CTN. We acknowledge the complexity of the ART exposure, and we will not be powered to tease out the effect of single ART drugs. However, we will conduct sensitivity analysis to account for cumulative ART exposure and by class, recent treatment interruptions and d-drugs exposure.