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A gathering storm: HIV infection and nonalcoholic fatty liver disease in low and middle-income countries


Despite the decreasing total incidence of liver-related deaths, liver disease remains one of the major non-AIDS causes of morbidity and mortality amongst people living with HIV, and a significant proportion of liver disease in these individuals can be attributed to nonalcoholic fatty liver disease (NAFLD). NAFLD in HIV infection is a growing problem in view of increasing life expectancy associated with the use of effective antiretroviral therapy (ART), wider uptake of ART and increasing rates of obesity in many Asian as well as western countries. The problem may be more pronounced in developing countries where there are limited resources available for mass screening and diagnosis of NAFLD. There is a small but growing body of literature examining NAFLD in the setting of HIV, with data from low and middle-income countries (LMICs) particularly lacking. Here, we review the cohort data on NAFLD in HIV, and discuss the risk factors, pathogenesis of hepatic steatosis, NAFLD and nonalcoholic steatohepatitis (NASH), diagnostic approaches and therapeutic options available for NAFLD in the setting of HIV, and the specific challenges of NAFLD in HIV for LMICs.


Kapoor N1,2, Audsley J3, Rupali P4, Sasadeusz J5, Paul TV1, Thomas N1, Lewin SR3,6. AIDS. 2019 Jun 1;33(7):1105-1115. doi: 10.1097/QAD.0000000000002161.

Author Information

1.  Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.

2.  Non-Communicable Disease Unit, Melbourne School of Population and Global Health, University of Melbourne.

3.  The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia.

4.  Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.

5.  Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity.

6.  Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia.

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