From nonalcoholic fatty liver to nonalcoholic steatohepatitis and cirrhosis in HIV-infected patients: diagnosis and management

Abstract

Purpose of review: Steatosis or nonalcoholic fatty liver disease (NAFLD) is commonly associated with abdominal obesity and metabolic disorders. It may evolve to severe liver injuries including nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. HIV-infected patients are aging and face an increased prevalence of abdominal obesity and metabolic disorders. We provide here an overview of NAFLD in HIV-infected patients for a better management of these patients.

Recent findings: Steatosis is observed in 30-40% of HIV-infected patients, associated with increased adiposity and metabolic disorders. Whereas steatosis has probably a benign prognosis, clinically silent lesions of NASH are frequent in patients undergoing liver biopsy with often fibrosis and even cirrhosis. Fibrosis severity is related to age, insulin resistance and stavudine/didanosine-based therapy. Noninvasive markers of fibrosis are useful for the management of NAFLD-suspected patients. In addition to lifestyle changes, new treatment options are emerging and need to be evaluated in these patients. Steatosis is also common in HIV-hepatitis C virus (HCV) co-infected patients and worsens fibrosis progression but does not impact on the rate of sustained virological response.

Summary: HIV-infected patients are at risk of NAFLD, a silent disease that can progress to more severe liver injuries. An accurate screening of these patients should be considered to prevent harmful evolution.