Non-alcoholic fatty liver disease (NAFLD) is a major emerging health challenge for people living with HIV, according to a review of evidence by doctors from the University Medical Center, Utrecht, published in the journal Infectious Disease Therapies.
NAFLD occurs when fat accumulates in liver cells, in people with low alcohol consumption. In some people fat accumulation will cause no symptoms but in a minority of people with NAFLD, fat accumulation leads to more serious liver damage in the form of non-alcoholic steatohepatitis (NASH) and cirrhosis. Around 10% of people with NAFLD develop NASH, and approximately one-third of people with NASH will go on to develop fibrosis or cirrhosis, resulting in declining liver function.
Immune activation caused by HIV and a history of treatment with the first generation of antiretroviral drugs, as well as the classic risk factors of obesity and metabolic syndrome, may place people living with HIV at higher risk of developing NAFLD and NASH.
A systematic review and meta-analysis published in 2017 found a prevalence of NAFLD in people living with HIV (PLHIV) of 35%, compared to a general population prevalence of 25%. The prevalence of NAFLD is much higher in PLHIV with persistent liver enzyme elevations; studies found prevalence ranged from 57 to 72%.
However, studies that have matched PLHIV with HIV-negative controls do not consistently find a higher prevalence in PLHIV and show that classic risk factors for NAFLD were more important than HIV-related factors.