This prospective HIV-NAT cohort in Bangkok followed 291 people with HIV aged at least 50 years from 2015–2024; 60 participants, or 20.6%, met non-invasive criteria for MASH at baseline. Over a median 5.9 years, baseline MASH was associated with steeper decline in Thai-validated MoCA scores after adjustment for multiple metabolic, social, and HIV-related factors, whereas MASLD without the MASH signal was not associated with decline. The findings support integrated liver and cognitive surveillance but do not show that treating MASH prevents cognitive deterioration.
Key findings
- Among 291 participants, 60.5% were male, median age was 54.4 years, and 60 participants or 20.6% met baseline MASH criteria.
- Across ages 50–80, adjusted mean MoCA decline was -4.79 points, 95% CI -7.49 to -2.09, with MASH versus -0.94, 95% CI -2.20 to -0.32, without MASH; p-interaction=0.007.
- Baseline MASLD overall was not significantly associated with cognitive decline, so all levels of steatotic liver disease should not be treated as equivalent risk.
Why this matters globally
As people with HIV age, metabolic disease, liver health, and brain health increasingly intersect. MASH may help identify people who warrant closer cognitive and cardiometabolic surveillance, but the benefit of FAST screening or MASH treatment for slowing cognitive decline requires external validation and intervention studies.
Thai researcher contribution
Seven named authors held Thai affiliations through Chulalongkorn University's Faculty of Medicine and the HIV-NAT Thai Red Cross AIDS and Infectious Diseases Research Centre. The study used a Thai-validated MoCA and longitudinal Bangkok data, with collaboration from Australia's Kirby Institute.
Limitations to consider
MASH was classified with the non-invasive FAST score rather than liver histology, and MoCA is a screening tool rather than a dementia diagnosis. Two principal cognitive assessments limit trajectory detail. The single Bangkok clinical cohort may not represent other populations, residual confounding remains possible, and the study cannot establish causality or treatment benefit.
Verify the original sources
Journal of the International AIDS SocietyJournal of the International AIDS Society↗DOI: 10.1002/jia2.70215