Publication Name	World Journal of Gastroenterology
Manuscript ID	120036
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Observational Study
Article Title	Immunometabolic drivers of metabolic dysfunction-associated steatotic liver disease in non-obese people living with human immunodeficiency virus
Manuscript Source	Unsolicited Manuscript
All Author List	Fei Ji, Li-Fan Zhang, Yang Gui, Zhen-Hong Qi, Yang Han, Na Su, Qing Zhang, Yan-Ling Li, Wei Zhao, Wei Lyu and Meng Yang
Funding Agency and Grant Number	Funding Agency Grant Number National Key RD Program of China No. 2023YFC2411705 National Natural Science Foundation of China No. U22A2023 National Natural Science Foundation of China No. 62325112 CAMS Innovation Fund for Medical Sciences No. 2025-I2M-XHJC-003 PUMCH Talent Development Support Program No. ULJ04684 National High-Level Hospital Clinical Research Funding No. 2025-PUMCH-C-052 National High-Level Hospital Clinical Research Funding No. 2022-PUMCH-D-008
Corresponding Author	Meng Yang, MD, PhD, Professor, Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. yangmeng_pumch@126.com
Key Words	Human immunodeficiency virus; Metabolic dysfunction-associated steatotic liver disease; Integrase strand transfer inhibitors; Antiretroviral therapy; Transient elastography
Core Tip	In virologically suppressed people living with human immunodeficiency virus (PLWH), metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent even in non-obese individuals. We report a paradoxical finding: A higher cluster of differentiation (CD) 4/CD8 ratio, a marker of favorable immune recovery, was independently associated with increased MASLD risk in non-obese PLWH (odds ratio = 8.55). This challenges the view that immune reconstitution is the sole therapeutic endpoint. Instead, metabolic risk stratification including routine steatosis assessment is warranted even in immunologically favorable, non-obese individuals. Integrase strand transfer inhibitors-based antiretroviral therapy demonstrated short-term hepatic safety.
Citation	Ji F, Zhang LF, Gui Y, Qi ZH, Han Y, Su N, Zhang Q, Li YL, Zhao W, Lyu W, Yang M. Immunometabolic drivers of metabolic dysfunction-associated steatotic liver disease in non-obese people living with human immunodeficiency virus. World J Gastroenterol 2026; In press

Received	2026-02-14 03:12
Peer-Review Started	2026-02-14 03:12
First Decision by Editorial Office Director	2026-04-04 02:59
Return for Revision	2026-04-04 02:59
Revised	2026-04-22 03:20
Publication Fee Transferred	2026-04-24 10:36
Second Decision by Editor	2026-05-09 02:37
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-05-09 10:41
Articles in Press	2026-05-09 10:41
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1007-9327 (print) and 2219-2840 (online)
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