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Review
. 2023 Apr 20;15(8):1990.
doi: 10.3390/nu15081990.

Nutritional and Lifestyle Therapy for NAFLD in People with HIV

Felice Cinque  1   2   3 , Annalisa Cespiati  2   3 , Rosa Lombardi  2   3 , Giovanni Guaraldi  4   5 , Giada Sebastiani  1
Affiliations
Review

Nutritional and Lifestyle Therapy for NAFLD in People with HIV

Felice Cinque et al. Nutrients. .

Abstract

HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.

Keywords: HIV; MAFLD; NAFLD therapy; diet; exercise; fatty liver; food insecurity; lean NASH; lifestyle; microbiota; nutrients.

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Conflict of interest statement

G.S. acted as speaker for Merck, Gilead, Abbvie, Novonordisk, Pfizer, served as an advisory board member for Pfizer, Merck, Novonordisk, Gilead, and has received unrestricted research funding from Theratechnologies Inc. G.G. received a research grant and speaker honoraria from Gilead, ViiV, Merck and Jansen and attended advisory boards of Gilead, ViiV and Merck. F.C., A.C. and R.L. declare no conflict of interest.

Figures

Figure 1
Figure 1
The role of nutrients in NAFLD in people with HIV. Among people with HIV, nutrition has a key impact in both NAFLD onset and regression. An unhealthy diet, rich in refined carbohydrates, fructose and sugar-added beverages, saturated FAs, and red and processed meat, along with alcohol abuse, are associated with fatty liver. Conversely, a healthy diet, with high intake of fruits, vegetables, whole grains, which are good sources of fibers, unsaturated FAs, white meat, dark chocolate, and coffee shows a beneficial effect on NAFLD. Abbreviations: NAFLD; non-alcoholic fatty liver disease; and FAs, fatty acids.
Figure 2
Figure 2
Lifestyle treatment of NAFLD in people with HIV. The goal of lifestyle treatment for NAFLD in PWH is weight loss, with a target of 7–10% in overweight/obese patients and 3–5% in lean individuals. Weight loss can be achieved through a patient-tailored approach, consisting of diet, physical activity, or, preferably, a combination of them. Calorie restriction diets such as Mediterranean diet, low-carbohydrate diets, low-fat diets, and intermittent fasting are recommended. Regarding physical activity, patients are advised to engage in at least 150 min of exercise (aerobic or resistance) per week, with possibly a minimum of 3–5 training sessions. Abbreviations: NAFLD, non-alcoholic fatty liver disease.
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