The prevalence of NAFLD may be as high as 40% among persons living with the human immunodeficiency virus (PLWH). Notably, Cardiovascular disease (CVDs) is an increasing concern among PLWH. However, the association of NAFLD with the risk of CVDs is unknown, and particularly, the relationship between NAFLD and CVD among PLWH has not been well elucidated. This study aimed to explore CVD events among PLWH with NAFLD compared to PLWH without NAFLD. Methods: This population-based, multicenter, retrospective cohort study was conducted using the TriNetX platform. All adult patients( .18 years) with HIV were identified, and among these, patients diagnosed with NAFLD were identified after excluding other chronic liver disease etiologies and included as the main group, and patients without NAFLD were included as controls (Non-NAFLD). We performed a 1:1 propensity score matching (PSM) for demographics, BMI, and comorbidities. The main outcome was major CVD events. Hazard ratio (HR) was calculated to compare the association of NAFLD with CVD outcomes. Results: A total of 151,868 PLWH were identified. Among these, 4,969 patients had NAFLD, and 146,899 patients without NAFLD were included in the control group. After PSM, PLWH with NAFLD and without NAFLD (4,463 patients) were well matched. The majority of the patients were men (60%) and White(70.1%) in both groups. Patients with NAFLD were more likely to have more comorbidities such as diabetes, hypertension, chronic respiratory disease, hypothyroidism, CKD, sleep apnea, and hyperlipidemia than the controls. In adjusted analysis (Table ), the risk of ischemic heart disease (
