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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Poor sleep and hepatic steatosis contribute to poorer quality of life in people with human immunodeficiency virus
Ana N Hyatt, Sai K Kuchana, Eduardo Vilar-Gomez, Richard K Sterling, Susanna Naggie, Sonya L Heath, Jennifer C Price, Laura A Wilson, Holly Crandall, Samer Gawrieh, Naga Chalasani, Rohit Loomba, Mark S Sulkowski, Archita P Desai, Jordan E Lake
Ana N Hyatt, Jordan E Lake, Department of Medicine, Division of Infectious Diseases, UTHealth Houston, Houston, TX 77030, United States
Sai K Kuchana, Eduardo Vilar-Gomez, Holly Crandall, Samer Gawrieh, Naga Chalasani, Archita P Desai, Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Richard K Sterling, Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA 23219, United States
Susanna Naggie, Department of Internal Medicine, School of Medicine, Clinical Research Institute, Duke University, Durham, NC 27708, United States
Sonya L Heath, Department of Internal Medicine, University of Alabama at Birmingham Medical Center, Birmingham, AL 35233, United States
Jennifer C Price, Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA 94143, United States
Laura A Wilson, Mark S Sulkowski, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, United States
Rohit Loomba, Department of Medicine, University of California San Diego, La Jolla, CA 92093, United States
Author contributions: Hyatt AN, Desai AP, and Lake JE wrote the manuscript; Hyatt AN, Kuchana SK, Vilar-Gomez E, Desai AP, and Lake JE analyzed the data; Sterling RK, Naggie S, Heath SL, Price JC, Wilson LA, Crandall H, Gawrieh S, Chalasani N, Loomba R, and Sulkowski MS performed the research and revised the manuscript for the human immunodeficiency virus non-alcoholic steatohepatitis clinical research network. All authors have read and approved the final manuscript.
Supported by National Institutes of Health, No. R01DK121378, No. R01DK126042, and No. P30DK120515.
Institutional review board statement: This study was approved by the Committee for the Protection of Human Subjects of UTHealth, No. HSC-MS-16-1064.
Informed consent statement: Each participant provided a signed informed consent prior to any study procedures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Some or all datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ana N Hyatt, MD, Department of Medicine, Division of Infectious Diseases, UTHealth Houston, 6431 Fannin Street, Houston, TX 77030, United States.
ana.n.hyatt@uth.tmc.edu
Received: May 6, 2025
Revised: May 28, 2025
Accepted: July 9, 2025
Published online: August 7, 2025
Processing time: 95 Days and 9.2 Hours
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.
Core Tip: The prevalence and burden of poor sleep in people with human immunodeficiency virus and metabolic dysfunction-associated steatotic liver disease (MASLD) and its impact on health-related quality of life (HRQoL) are not well described. We studied these complex relationships in a cohort of 1005 virologically suppressed adult people with human immunodeficiency virus and MASLD, who underwent vibration-controlled transient elastography and self-reported questionnaires at eight United States centers. MASLD prevalence was high, 64% had poor sleep quality and HRQoL was low overall. There was no association between MASLD and sleep quality but poor sleep, MASLD and liver fibrosis were independently associated with poor HRQoL.
