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

Abstract

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.

Keywords: Health-related quality of life; Human immunodeficiency virus; Liver fibrosis; Metabolic dysfunction-associated steatotic liver disease; Sleep disorders.