Chronic HIV infection poses a persistent challenge to liver health. Even under virological suppression, chronic inflammation, metabolic alterations (such as insulin resistance and dyslipidemia), and antiretroviral adverse effects contribute to an increased risk of liver injury, including fibrosis and steatosis 1. This study aimed to compare liver stiffness and the degree of steatosis between PLWHA and individuals monoinfected with hepatitis C virus (HCV), HIV-negative, using non-invasive methods.

Retrospective cross-sectional study including 158 PLWHA and 267 HCV-positive/HIV-negative individuals evaluated between January 2024 and June 2025. Socio-epidemiological variables (sex assigned at birth, age), body mass index (BMI), liver stiffness (kPa) by 2D-SWE elastography, and steatosis grade (S0–S3) estimated using USFF software on a Samsung RS85 system were analyzed. Comparisons were performed using Mann–Whitney and chi-square tests.

PLWHA had significantly lower median age than the control group (58 vs. 62 years; p = 0.002), higher proportion of males (79.1% vs. 46.4%; p < 0.001), and lower BMI (24.9 vs. 26.8 kg/m²; p = 0.007). Steatosis prevalence was significantly higher among PLWHA (32.3% vs. 11.5%; p < 0.001), while liver stiffness was lower (median 4.9 vs. 6.0 kPa; p < 0.001), with a lower proportion of advanced fibrosis (16.8% vs. 35.6%; p < 0.001). No significant correlation was found between steatosis and fibrosis in either group (p > 0.05).

Despite the potential chronic inflammatory effect of HIV, lower liver stiffness was observed among PLWHA, suggesting that factors such as age, sex, BMI, and metabolic profile play a key role in determining these outcomes. The higher prevalence of steatosis among PLWHA may be related to prolonged antiretroviral use or specific metabolic alterations. The absence of correlation between steatosis and fibrosis suggests distinct pathophysiological mechanisms. Liver elastography and automated steatosis quantification by USFF are effective, non-invasive, and promising tools for screening silent hepatic alterations, and their inclusion in PLWHA care routines is recommended.