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Liver Disease in People Living with HIV

Advances in the effectiveness of HIV treatment have significantly improved the life expectancy of people with HIV. As a result, people with HIV are increasingly likely to face mortality due to diseases associated with aging, such as diabetes and heart disease, rather than AIDS. Recent reports suggest that liver disease, in particular, has emerged as an important health concern among this population.

According to previous research, liver disease is the most common non-AIDS cause of death among HIV-positive people. The high rate of coinfection with HIV and viral hepatitis helps explain why HIV-positive people, on average, experience more health issues related to the liver. Thankfully, the availability of treatments for viral hepatitis means that deaths related to the liver are decreasing in HIV-positive people. Still, a new study of people infected with HIV suggests that liver disease unrelated to viral hepatitis or alcohol intake continues to be a major health concern.

Researchers pooled the data of ten previous studies of non-alcoholic fatty liver disease (NAFLD) in people infected with HIV. This condition refers to the accumulation of fat in the liver that may lead to cirrhosis or even liver cancer. To focus specifically on the role of HIV in liver disease, data from HIV-positive people with hepatitis B or C and those with heavy alcohol consumption were excluded from the study. Clinicians used liver imaging techniques to assess the prevalence of NAFLD in 1,256 HIV-positive patients from a variety of countries including Italy, Canada and China.

The results, to be published next week in the journal AIDS, suggest that NAFLD is more common among people with HIV than previously thought. Fatty liver disease unrelated to alcohol or viral hepatitis was present in over 35% of people with HIV in the analysis. For comparison, the prevalence of NAFLD in the general population is about 25%.

Cases of NAFLD can be classified as either simple fatty liver or nonalcoholic steatohepatitis (NASH). Whereas people with simple fatty liver rarely experience health complications, those with NASH experience liver inflammation that can lead to fibrosis or cancer. Researchers found that 42% of people with NAFLD in the study had NASH – an unusually high proportion given that this condition arises in only 20% of people with NAFLD in the general (HIV-negative) population. In other words, HIV-positive people in the study not only presented with unusually high levels of non-alcoholic liver disease; but a greater proportion of NAFLD cases among HIV-positive people were clinically severe.

Researchers also assessed study participants for a variety of other biometric data, such as body mass index (BMI) and blood levels of cholesterol and triglycerides. As seen in the general population, HIV-positive people with high levels of blood cholesterol and high BMI had an increased risk of NAFLD. Interestingly, high T cell count was associated with increased risk for NAFLD, which suggests there may be an immune system role in liver disease.

Caryn Morse, an infectious disease physician at the National Institutes of Health, asserts that fatty liver disease is “common, underappreciated, and understudied” in people with HIV. She emphasized that people with HIV and their physicians need to pay attention to clinical indications of liver disorders, such as elevated levels of liver enzyme aminotransferase. Moreover, future research is needed to determine whether lifetime exposure to certain classes of HIV medication may contribute to the elevated levels of NAFLD in HIV-positive people.

Since people with HIV may be at an increased risk for developing fatty liver disease, it is especially important to proactively maintain liver wellness through a healthy lifestyle. Limiting alcohol intake, increasing aerobic exercise, and eating foods low in fat and cholesterol are all preventive measures to reduce one’s risk of fatty liver disease. People with HIV can take advantage of these strategies to help compensate for their underlying risk for this disease.