{"id":14188,"date":"2023-12-01T12:00:10","date_gmt":"2023-12-01T12:00:10","guid":{"rendered":"http:\/\/i-base.info\/guides\/?page_id=14188"},"modified":"2023-12-23T11:32:28","modified_gmt":"2023-12-23T11:32:28","slug":"hiv-and-fatty-liver-disease","status":"publish","type":"page","link":"https:\/\/i-base.info\/guides\/side\/hiv-and-fatty-liver-disease","title":{"rendered":"HIV and fatty liver disease"},"content":{"rendered":"<p>This information about live health is available as a <a href=\"https:\/\/i-base.info\/guides\/wp-content\/uploads\/2019\/12\/NAFLD-leaflet-A4.pdf\" target=\"_blank\">leaflet in PDF format<\/a>.<\/p>\n<p><strong>Fatty liver disease involves a build up of fat in the liver. In most cases this can be mild and without symptoms. Greater fat changes increase the risk of serious complications.<\/strong><\/p>\n<ul>\n<li>Fatty liver disease is linked to a range of other liver problems.<\/li>\n<li>It is very common in the general population and also affects one-third of HIV positive people.<\/li>\n<li>HIV is associated with more advanced fatty liver disease.<\/li>\n<\/ul>\n<p>Fatty liver disease can sometimes be caused by high alcohol use.<\/p>\n<p>This leaflet is mainly about non-alcoholic fatty liver disease (NAFLD). Other terms might be used to describe these symptoms in the future. [1]<\/p>\n<h2>What does the liver do?<\/h2>\n<p>The liver is in the upper right hand side of the abdomen (above the stomach).<\/p>\n<p>It stores fuel (glycogen), and makes cholesterol and proteins (including some that make the blood clot).<\/p>\n<p>The liver also removes toxins from your body and produces bile to help digest fat.<\/p>\n<h2>What is non-alcoholic fatty liver disease (NAFLD)?<\/h2>\n<p>Fatty liver disease refers to a range of conditions that come from changes in the way fat is stored in your liver. Usually this means a build up of fat inside liver cells.<\/p>\n<p>Although alcohol can be a cause of fatty liver, NAFLD refers to when alcohol is not involved.<\/p>\n<p>Also, although being overweight is a common risk, many people with NAFLD can have a normal weight.<\/p>\n<h2>How common is NAFLD in HIV positive people?<\/h2>\n<p>Several studies have reported that around 1-in-3 HIV positive people have NAFLD (30%). This will mostly be mild-stage with most people not diagnosed.<\/p>\n<p>This percentage is likely to increase as HIV positive people get older.<\/p>\n<h2>How serious is NAFLD?<\/h2>\n<p>Like most symptoms fatty liver disease can range from mild to severe.<\/p>\n<p>The risks from mild disease are very low. Without testing most people don\u2019t know they have it.<\/p>\n<p>A healthy liver contains only small amounts of fat. Slight increases of fat in early stage NAFLD generally don\u2019t cause problems.<\/p>\n<p>In later stages, with more fat build up, NAFLD causes fibrous tissue. This can develop into severe scarring (cirrhosis). In some cases, this can lead to liver failure or liver cancer.<\/p>\n<p>NAFLD can also be linked to other serious problems including poor sleep, diabetes, heart disease, stroke and kidney disease.<\/p>\n<p>The earlier NAFLD is diagnosed and treated, the easier it is to stop or reverse these conditions and risks.<\/p>\n<p><span style=\"font-size: 1.4em;\">What causes NAFLD?<\/span><\/p>\n<p>Although high alcohol use is a common cause of fatty liver disease, there are equally important non-alcoholic causes.<\/p>\n<p>NAFLD is mainly caused by changes in body processes linked to sugar and fat. Some people may be genetically at greater risk of developing NAFLD.<\/p>\n<p>NAFLD is often linked to:<\/p>\n<ul>\n<li>Being overweight (BMI &gt;30) especially with belly fat.<\/li>\n<li>Increased waist. This is above 40\u201d\/102 cm in men and above 35\u201d\/88 cm in women.<\/li>\n<li>High blood pressure.<\/li>\n<li>High levels of bad cholesterol (LDL and triglycerides) or low levels of good cholesterol (HDL).<\/li>\n<li>Insulin resistance and type 2 diabetes when cells don\u2019t respond normally to the hormone insulin so that sugars stay longer in the bloodstream.<\/li>\n<\/ul>\n<p>Fatty liver can also be caused by other conditions:<\/p>\n<ul>\n<li>Untreated hepatitis B or C.<\/li>\n<li>A side effect from other medicines including some antidepressants, steroids and other hormones.<\/li>\n<li>Other rarer causes eg iron build up, coeliac disease, rapid weight loss.<\/li>\n<\/ul>\n<p>Additionally, some HIV-related factors may be associated with higher risk of fatty liver:<\/p>\n<ul>\n<li>Lipodystrophy.<\/li>\n<li>Some early HIV meds (older NRTIs and PIs).<\/li>\n<li>Additionally, HIV may play a role in fatty liver disease, for example, by causing inflammation, immune activation and changes to lipid levels.<\/li>\n<li>NAFLD can affect people at any age, including children. It is more common though in adults older than 50 years and more common in men compared to women.<\/li>\n<\/ul>\n<h2>How is NAFLD diagnosed?<\/h2>\n<p>Unless it progresses, most people with mild NAFLD are not diagnosed.<\/p>\n<p>A blood test is often an important signal if liver enzymes (ALT and\/or AST) are increased. Routine HIV monitoring includes these liver enzyme tests.<\/p>\n<p>However, NAFLD can be present even when these tests are normal.<\/p>\n<p>When NAFLD is suspected, imaging scans can be more accurate. These include ultrasound, CT and MRI scans. A Fibroscan can show how much fibrosis (scarring) is present. Biopsy is only recommended when there is a high risk or uncertain diagnosis. This is when a sample of liver tissue is removed and looked at under a microscope,<\/p>\n<h2>Stages of NAFLD<\/h2>\n<p>The main stages of NAFLD are:<\/p>\n<ul>\n<li>Simple steatosis. This is mild fat accumulation without inflammation: 80-90% people with NAFLD.<\/li>\n<li>Non-alcoholic steatohepatitis (NASH) is a more advanced form of NAFLD: 10-20% of people with NAFLD. NASH involves the stage where extra fat in your liver has caused liver inflammation.<\/li>\n<li>Fibrosis: 25-50% of people with NASH.<\/li>\n<li>Cirrhosis: 2-5% per year of people with fibrosis.<\/li>\n<li>Hepatic cancer: 2-3% per year of people with cirrhosis.<\/li>\n<\/ul>\n<h2>Treatment and management<\/h2>\n<p>The main management for NAFLD usually involves lifestyle changes.<\/p>\n<ul>\n<li>Diet changes and weight loss if your NAFLD is linked to being overweight. A 10% weight loss can significantly reduce the amount of fat in your liver.<\/li>\n<li>Being active &#8211; exercise has additional benefits to the effect on reducing weight.<\/li>\n<li>Monitoring response to weight loss.<\/li>\n<li>Treating dyslipidaemia &#8211; ie reducing triglycerides and bad cholesterol.<\/li>\n<li>Reducing alcohol.<\/li>\n<\/ul>\n<p>Vitamin E and pioglitazone are sometimes used to treat late stage NAFLD. The evidence for their use is not strong and they may have serious side effects.<\/p>\n<p>Bariatric surgery to reduce weight can be used to manage NAFLD.<\/p>\n<p>Other approaches involve treating the complications that are linked to NAFLD, For eample, to reduce high blood pressure or high triglycerides or to treat diabetes.<\/p>\n<h2>Future research<\/h2>\n<p>Several ongoing studies are looking at other drugs to reduce inflammation or fibrosis. These include elafibranor, obeticholic acid, selonsertib, simtuzumab<span class=\"Apple-converted-space\">\u00a0 <\/span>(a monoclonal antibody) and cenicriviroc.<\/p>\n<p>Studies in HIV positive people include using aramchol, maraviroc, metformin, raltegravir and tesamorelin.<\/p>\n<p>A phase 2 study published in March 2023 reported no benefit on NASH from using semaglutide.<\/p>\n<p>Researchers are also looking at different names to describe NAFLD. [1]<\/p>\n<h2>References<\/h2>\n<ol>\n<li>Noureddin M et al. Embracing Change: From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease Under the Steatotic Liver Disease Umbrella. Clin Gastroenterol Hepatol. 2023 Oct 15:S1542-3565(23)00833-9. doi: 10.1016\/j.cgh.2023.09.034.<br \/>\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37848118\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/37848118\/<\/a><\/li>\n<\/ol>\n<h2>Links<\/h2>\n<p><strong>Diagnosis and Management of Nonalcoholic Fatty Liver Disease.<\/strong> Leung PB et al.\u00a0<em>JAMA.<\/em>\u00a0doi:10.1001\/jama.2023.17935. (16 October 2023).<br \/>\n<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2810964\">https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2810964<\/a><\/p>\n<p><b>Updated practice guidance fatty liver:\u00a0State of the art new practice guidelines for NAFLD . Updates to 2018 guidelines. (Nov 2022).<\/b><br \/>\n<a href=\"https:\/\/natap.org\/2022\/AASLD\/AASLD_107.htm\">https:\/\/natap.org\/2022\/AASLD\/AASLD_107.htm<\/a><\/p>\n<p><strong>Diagnosis and management of nonalcoholic fatty liver disease patient guideline<\/strong><br \/>\nAmerican Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Setting [2018, updated May 2022]<br \/>\n<a href=\"https:\/\/journals.lww.com\/cld\/Fulltext\/2022\/06000\/The_diagnosis_and_management_of_nonalcoholic_fatty.3.aspx\">https:\/\/journals.lww.com\/cld\/Fulltext\/2022\/06000\/The_diagnosis_and_management_of_nonalcoholic_fatty.3.aspx<\/a><\/p>\n<p>Riebensahm C et al.\u00a0Decreased physical activity and prolonged sitting time are associated with liver steatosis in people with HIV. JAIDS Journal of AIDS), 23 November 2023. DOI: 10.1097\/QAI.0000000000003328.<br \/>\n<a href=\"https:\/\/journals.lww.com\/jaids\/abstract\/9900\/decreased_physical_activity_and_prolonged_sitting.322.aspx\">https:\/\/journals.lww.com\/jaids\/abstract\/9900\/decreased_physical_activity_and_prolonged_sitting.322.aspx<\/a><\/p>\n<p class=\"article-header__title smaller\">Loomna R et al. Semaglutide 2\u00b74 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial. Lancet (16 March 2023)..<br \/>\n<a class=\"loa__item__name faded article-header__info__ctrl article-header__footnotes\" href=\"https:\/\/www.thelancet.com\/journals\/langas\/article\/PIIS2468-1253(23)00068-7\/fulltext#\" data-db-target-for=\"foot-notes\" aria-expanded=\"false\" aria-controls=\"\"><span class=\"article-header__doi bulleted\"><span class=\"article-header__doi__label\">DOI:<\/span><\/span><\/a><a class=\"article-header__doi__value\" href=\"https:\/\/doi.org\/10.1016\/S2468-1253(23)00068-7\">https:\/\/doi.org\/10.1016\/S2468-1253(23)00068-7<\/a><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>This information about live health is available as a leaflet in PDF format. Fatty liver disease involves a build up of fat in the liver. In most cases this can be mild and without symptoms. Greater fat changes increase the &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":291,"menu_order":34,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-14188","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/14188","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/comments?post=14188"}],"version-history":[{"count":6,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/14188\/revisions"}],"predecessor-version":[{"id":16902,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/14188\/revisions\/16902"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/pages\/291"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/guides\/wp-json\/wp\/v2\/media?parent=14188"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}