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Hepatic steatosis (HS) related to nonalcoholic fatty liver disease (NAFLD) is increasing globally. In people living with human immunodeficiency virus (PLWH) risk factors of HS are increased. The impact of HS on outcomes and in particular health‐related quality of life (HRQL) in PLWH remains unknown. The aim of this cross‐sectional cohort study (FLASH, Prevalence of Advanced Fibrosis in Patients Living With HIV) was to determine the contribution of HS on HRQL in PLWH and to identify confounders on HRQL. A total of 245 PLWH were prospectively enrolled. HS was assessed using vibration‐controlled transient elastography and defined as a controlled attenuation parameter (CAP) of ≥ 275 dB/m. The analysis was performed between CAP < 275 and ≥ 275 dB/m. The generic European Quality‐of‐Life 5‐Dimension 5‐Level questionnaire was used to determine differences in the HRQL. Univariable and multivariable linear regression models were applied to identify predictors with impaired HRQL in both groups. In this cohort, 65% (n = 160) presented without and 35% (n = 85) with HS, of whom most had NAFLD (n = 65, 76.5%). The HRQL (UI‐value) was significantly lower in PLWH and steatosis (0.86 ± 0.18) in comparison with no steatosis (0.92 ± 0.13). Unemployment ( p  = 0.025) and waist circumference ( p  = 0.017) remained independent predictors of a poor HRQL in the steatosis subgroup. In turn, age ( p  = 0.045), female sex ( p  = 0.030), body mass index ( p  = 0.010), and arterial hypertension ( p  = 0.025) were independent predictors of a low HRQL in the subgroup without steatosis.  Conclusion:  HS and metabolic comorbidities negatively affect the HRQL. Addressing these factors may improve patient‐reported and liver‐related outcomes in PLWH.

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV