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.

Non-alcoholic fatty liver disease (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 the metabolic syndrome, may place people living with HIV
at higher risk of developing non-alcoholic fatty liver disease and
non-alcoholic steatohepatitis (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.