Nonalcoholic Fatty Liver Disease is an HIV Threat

Excessive alcohol intake can cause liver disease.  What is not so well understood is the higher frequency of nonalcoholic fatty liver disease in persons living with HIV. There are three types of fatty liver: Nonalcoholic fatty liver disease (NAFLD), Nonalcoholic steatohepatitis (known as fatty liver or NASH) which is more serious, and the most serious which is fibrosis/cirrhosis. It is the most serious because it can lead to liver failure.  The presence of these conditions may be confirmed by ultrasound although sometimes a liver biopsy is also necessary.  In a large study of people with HIV, the frequency of NAFLD, biopsy-proven NASH, and fibrosis were 35%, 42%, and 22%, respectively. These percent estimates are much higher than seen in the general population.

The mechanisms that increase the frequency of NAFLD in those living with HIV are unclear. It could be because of the effects of HIV itself, ART therapy, or various comorbid risk factors, such as Type 2 diabetes, lipid problems, and hypertension. Of most importance is that about half of cases occurred in those who were overweight or obese. In terms of treatment, there must be increased emphasis on physical activity and dietary changes to decrease weight.  Weight loss of 10% or more of total body weight is often found to improve NAFLD considerably.  A decrease or complete elimination of alcohol intake is also recommended.  At this time there are no approved medications for treating NAFLD, but various medications are under study.

Because of its frequency, the prevention, diagnosis, and treatment of NAFLD are of great importance.  Also, many of the treatment approaches can have positive side effects in reducing risk of other diseases, such as cardiovascular disease, diabetes, and hypertension. Overall, reducing these risks also serves the purpose of increasing longevity and quality of life.


Source: Zahra Qamar, et al.;  (2021) NAFLD Is Increasingly Affecting Patients With HIV. Contagion, April 2021 (Vol. 06, No. 02). Available at