Incidence of non-alcoholic fatty liver disease in antiretroviral therapy-naïve people with human immunodeficiency virus who start DTG/ABC/3TC compared to BIC/FTC/TAF at 48-week follow-up.

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To determine the incidence of non-alcoholic fatty liver disease (NAFLD) by non-invasive methods in people living with HIV (PLWH). Prospective cohort, in PLWH naïve to antiretroviral therapy, starting bictegravir (BIC) or dolutegravir (DTG) at the Hospital de Infectología "La Raza", in Mexico City, from February 2021 to August 2023. We measured at baseline and 48weeks triglycerides and glucose index (TyG), fatty liver index (FLI), hepatic steatosis index (HSI) and liver ultrasonography; relative risk (RR) for developing NAFLD was determined. At 48weeks, TyG index in BIC-group 4.54 (IQR 4.36-4.75), in DTG-group 4.66 (IQR 4.49-4.80), p = .080; HSI in BIC-group 30.30 (IQR 28.12-33.70), in DTG-group 30.85 (IQR 28.02-34.50), p = .650; FLI in BIC-group 14.88 (IQR 7.91-31.80), in DTG-group 19.49 (IQR 8.49-32.28), p = .729; NAFLD was detected by US in 6 [10.3% (95%CI 4.8%-20.7%)] in BIC-group and, 7 [10.9% (95%CI 6.4%-20.9%)] in DTG-group, p = .916. Risk factors for NAFLD development were baseline BMI ≥25kg/m2, baseline HDL-c <40mg/dL, and FIB-4 >1.3 at 48weeks. There is a high incidence of NAFLD in PLWH who start a second generation INSTI at 48weeks; baseline overweight, low HDL-cholesterol and FIB-4 >1.3 at 48weeks of treatment were independent risk factors for NAFLD development.