Understanding Liver Disease in People Living with HIV

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a chronic liver condition characterized by excessive fat accumulation in the liver, not caused by alcohol. It is a growing global health concern, often progressing to steatohepatitis (MASH), fibrosis, cirrhosis, and even liver cancer. People living with HIV (PLWH) face a significantly higher risk of developing MASLD due to a complex interplay of factors including chronic inflammation, antiretroviral therapy (ART) side effects, and metabolic dysregulation. Despite this increased vulnerability, the specific mechanisms and optimal management strategies for MASLD in PLWH remain incompletely understood, highlighting a critical knowledge gap.

The review highlights that MASLD is highly prevalent among PLWH, with reported rates ranging from 25% to 50%, significantly higher than in the general population. Key contributing factors include insulin resistance, dyslipidemia, chronic inflammation, and specific ART drugs like efavirenz or older nucleoside reverse transcriptase inhibitors (NRTIs). The authors emphasize that diagnosing MASLD in PLWH can be challenging due to overlapping symptoms and the need for non-invasive assessment tools. The most critical finding is the urgent need for integrated screening protocols and tailored management strategies for MASLD within HIV care, given its distinct pathological drivers and accelerated progression risk in this vulnerable group. The review underscores that while general MASLD management principles apply, the unique metabolic milieu of PLWH necessitates a more nuanced approach, particularly concerning drug interactions and immune system considerations.