Skip to main content
SpringerLink
Log in

Fatty Liver in HIV-Infected Persons

  • HIV/AIDs (C Yoon, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Abstract

The high efficacy of new antiretroviral regimens has deeply improved survival of patients living with HIV (PLWH), and currently as the population ages, the focus has shifted to comorbidities especially metabolic disorders which includes nonalcoholic fatty liver disease (NAFLD).

Recent Findings

Metabolic syndrome is often associated with increased cardiovascular risk that, in turn, is becoming one of the leading causes of death in PLWH. Another important consequence of metabolic syndrome is NAFLD where there is an increasing incidence among PLWH and if progresses could evolve in terminal chronic liver failure. Lipodystrophy, deregulation of the gut-liver axis, and HIV infection itself may contribute simultaneously to NAFLD pathogenesis. Lifestyle modification is the main treatment since no drug has specifically been approved for use in persons with NAFLD, although novel medications and studies are actively being researched.

Summary

PLWH have a higher risk for fatty liver disease that is likely due variety risk factors including direct and indirect viral effects, medications, along with the higher prevalence of metabolic syndrome and lipodystrophy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Guaraldi G, Lonardo A, Maia L, Palella FJ Jr. Metabolic concerns in aging HIV-infected persons: from serum lipid phenotype to fatty liver. AIDS. 2017;31(Suppl 2):S147–56. https://doi.org/10.1097/QAD.0000000000001483.

    Article  PubMed  Google Scholar 

  2. Crum-Cianflone N, Krause D, Wessman D, Medina S, Stepenosky J, Brandt C, et al. Fatty liver disease is associated with underlying cardiovascular disease in HIV-infected persons(*). HIV Med. 2011;12(8):463–71. https://doi.org/10.1111/j.1468-1293.2010.00904.x.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Morrison M, Hughes HY, Naggie S, Syn WK. Nonalcoholic fatty liver disease among individuals with HIVmono-infection: A growing concern? Dig Dis Sci. 2019;64(12):3394–401. https://doi.org/10.1007/s10620-019-05861-7.

    Article  PubMed  Google Scholar 

  4. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–21.

    Article  Google Scholar 

  5. Luis Calzadilla B, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17:774.

    Article  Google Scholar 

  6. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and nonalcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–85.

    Article  CAS  Google Scholar 

  7. Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–31.

    Article  Google Scholar 

  8. Marchesini G, Babini M. Nonalcoholic fatty liver disease and the metabolic syndrome. Minerva Cardioangiol. 2006;54:229–39.

    CAS  PubMed  Google Scholar 

  9. Pagano G, Pacini G, Musso G, Gambino R, Mecca F, Depetris N, et al. Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: further evidence for an etiologic association. Hepatology (Baltimore, MD). 2002;35:367–72.

    Article  CAS  Google Scholar 

  10. Armstrong MJ, Adams LA, Canbay A, Syn WK. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59:1174–97.

    Article  CAS  Google Scholar 

  11. Maurice JB, Garvey L, Tsochatzis EA, Wiltshire M, Cooke G, Guppy N, et al. Monocyte-macrophage activation is associated with non alcoholic fatty liver disease and liver fibrosis in HIV monoinfection independently of the gut microbiome and bacterial translocation. AIDS. 2019;33(5):805–14. https://doi.org/10.1097/QAD.0000000000002133.

    Article  CAS  PubMed  Google Scholar 

  12. Debes JD, Bohjanen PR, Boonstra A. Mechanisms of accelerated liver fibrosis progression during HIV infection. J Clin Transl Hepatol. 2016;4:328–35.

    PubMed  PubMed Central  Google Scholar 

  13. Bruno R, Galastri S, Sacchi P, Cima S, Caligiuri A, DeFranco R, et al. gp120 modulates the biology of human hepatic stellate cells: a link between HIV infection and liver fibrogenesis. Gut. 2010;59(4):513–20.

    Article  CAS  Google Scholar 

  14. Woreta TA, Sutcliffe CG, Mehta SH, Brown TT, Higgins Y, Thomas DL, et al. Incidence and risk factors for steatosis progression in adults coinfected with HIV and hepatitis C virus. Gastroenterology. 2011;140(3):809–17.

    Article  Google Scholar 

  15. Coronel-Castillo CE, Qi X, Contreras-Carmona J, Ramírez Pérez OL, Méndez-Sánchez N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in HIV infection: a metabolic approach of an infectious disease. Expert Rev Gastroenterol Hepatol. 2019;13(6):531–40. https://doi.org/10.1080/17474124.2019.1599284.

    Article  CAS  PubMed  Google Scholar 

  16. Lake JE, Wu K, Bares SH, Debroy P, Godfrey C, Koethe JR, et al. Clin Infect Dis. 2020:ciaa177. https://doi.org/10.1093/cid/ciaa177.

  17. Guaraldi G, Squillace N, Stentarelli C, Orlando G, D'Amico R, Ligabue G, et al. Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: prevalence, characteristics, and predictors. Clin Infect Dis. 2008;47:250–7.

    Article  Google Scholar 

  18. Crum-Cianflone N, Dilay A, Collins G, Asher D, Campin R, Medina S, et al. Nonalcoholic fatty liver disease among HIV-infected persons. J Acquir Immune Defic Syndr (1999). 2009;50:464–73.

    Article  Google Scholar 

  19. Lombardi R, Sambatakou H, Mariolis I, Cokkinos D, Papatheodoridis GV, Tsochatzis EA. Prevalence and predictors of liver steatosis and fibrosis in unselected patients with HIV monoinfection. Dig Liver Dis. 2016;48:1471–7.

    Article  Google Scholar 

  20. Vodkin I, Valasek MA, Bettencourt R, Cachay E, Loomba R. Clinical, biochemical and histological differences between HIVassociated NAFLD and primary NAFLD: a case-control study. Aliment Pharmacol Ther. 2015;41:368–78.

    Article  CAS  Google Scholar 

  21. Morse CG, McLaughlin M, Matthews L, Proschan M, Thomas F, Gharib AM, et al. Nonalcoholic steatohepatitis and hepatic fibrosis in HIV-1-monoinfected adults with elevated aminotransferase levels on antiretroviral therapy. Clin Infect Dis. 2015;60:1569–78.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Maurice JB, Patel A, Scott AJ, Patel K, Thursz M, Lemoine M. Prevalence and risk factors of nonalcoholic fatty liver disease in HIV-monoinfection. AIDS (London, England). 2017;31:1621–32.

    Article  Google Scholar 

  23. Price JC, Seaberg EC, Latanich R, Budoff MJ, Kingsley LA, Palella FJ Jr, et al. Risk factors for fatty liver in the multicenter AIDS cohort study. Am J Gastroenterol. 2014;109:695–704.

    Article  CAS  Google Scholar 

  24. Kardashian A, Ma Y, Scherzer R, Price JC, Sarkar M, Korn N, et al. Sex differences in the association of HIV infection with hepatic steatosis. AIDS (London, England). 2017;31:365–73.

    Article  CAS  Google Scholar 

  25. Lichtenstein KA, Ward DJ, Moorman AC, Delaney KM, Young B, Palella FJ Jr, et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS. 2001;15:1389–98.

    Article  CAS  Google Scholar 

  26. Carr A. HIV lipodystrophy: risk factors, pathogenesis, diagnosis and management. AIDS. 2003;17(Suppl 1):S141–8.

    Article  CAS  Google Scholar 

  27. Lana LG, Junqueira DR, Perini E, de Menezes PC. Lipodystrophy among patients with HIV infection on antiretroviral therapy: a systematic review protocol. BMJ Open. 2014;4(3):e004088.

    Article  Google Scholar 

  28. Sutinen J, Häkkinen AM, Westerbacka J, Seppälä-Lindroos A, Vehkavaara S, Halavaara J, et al. Increased fat accumulation in the liver in HIV-infected patients with antiretroviral therapy associated lipodystrophy. AIDS. 2002;16(16):2183–93.

    Article  CAS  Google Scholar 

  29. Vallet-Pichard A, Mallet V, Pol S. Nonalcoholic fatty liver disease and HIV infection. Semin Liver Dis. 2012;32(2):158–66.

    Article  CAS  Google Scholar 

  30. Gervasoni C, Cattaneo D, Filice C, Galli M, Gruppo Italiano Studio-NASH in malattie infettive. Drug-induced liver steatosis in patients with HIV infection. Pharmacol Res. 2019;145:104267. https://doi.org/10.1016/j.phrs.2019.104267.

    Article  CAS  PubMed  Google Scholar 

  31. Calza L, Colangeli V, Borderi M, Coladonato S, Tazza B, Fornaro G, et al. Improvement in liver steatosis after the switch from a ritonavir-boosted protease inhibitor to raltegravir in HIV-infected patients with non-alcoholic fatty liver disease. Infect Dis (Lond). 2019;51(8):593–601. https://doi.org/10.1080/23744235.2019.1629008.

    Article  CAS  Google Scholar 

  32. Price JC, Thio CL. Liver disease in the HIV-infected individual. Clin Gastroenterol Hepatol. 2010;8(12):1002–12.

    Article  Google Scholar 

  33. Marchetti G, Tincati C, Silvestri G. Microbial translocation in the pathogenesis of HIV infection and AIDS. Clin Microbiol Rev. 2013;26(1):2–18.

    Article  CAS  Google Scholar 

  34. Sasso M, Beaugrand M, de Ledinghen V, Douvin C, Marcellin P, Poupon R, et al. Controlled attenuation parameter (CAP): a novel VCTE guided 600 ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–35.

    Article  Google Scholar 

  35. Paul J, Venugopal RV, Peter L, Shetty KNK, Shetti MP. Measurement of controlled attenuation parameter: a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification – a prospective follow-up study. Arq Gastroenterol. 2018;55:7–13.

    Article  Google Scholar 

  36. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–78.e5; quiz e14–5. https://doi.org/10.1053/j.gastro.2015.04.005.

    Article  PubMed  Google Scholar 

  37. Armstrong MJ, Houlihan DD, Rowe IA. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;363(12):1185; author reply 1186. https://doi.org/10.1056/NEJMc1006581.

    Article  CAS  PubMed  Google Scholar 

  38. Sebastiani G, Saeed S, Lebouche B, de Pokomandy A, Szabo J, Haraoui LP, et al. Vitamin E Is an effective treatment for nonalcoholic steatohepatitis in HIV mono-infected patients. AIDS. 2020;34(2):237–44. https://doi.org/10.1097/QAD.0000000000002412.

    Article  PubMed  Google Scholar 

  39. Oseini AM, Sanyal AJ. Therapies in nonalcoholic steatohepatitis (NASH). Liver Int. 2017;37(Suppl 1):97–103.

    Article  Google Scholar 

  40. Meissner EG, McLaughlin M, Matthews L, Gharib AM, Wood BJ, Levy E, et al. Simtuzumab treatment of advanced liver fibrosis in HIV and HCV-infected adults: results of a 6-month open-label safety trial. Liver Int. 2016;36(12):1783–92. https://doi.org/10.1111/liv.13177.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Bertola A, Bonnafous S, Anty R, Patouraux S, Saint-Paul MC, Iannelli A, et al. Hepatic expression patterns of inflammatory and immune response genes associated with obesity and NASH in morbidly obese patients. PLoS One. 2010;5(10):e13577. https://doi.org/10.1371/journal.pone.0013577.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Sherman KE, Abdel-Hameed E, Rouster SD, Shata MTM, Blackard JT, Safaie P, et al. Improvement in hepatic fibrosis biomarkers associated with chemokine receptor inactivation through mutation or therapeutic blockade. Clin Infect Dis. 2019;68(11):1911–8. https://doi.org/10.1093/cid/ciy807.

    Article  CAS  PubMed  Google Scholar 

  43. Coppola N, Perna A, Lucariello A, Martini S, Macera M, Carleo MA, et al. Effects of treatment with Maraviroc a CCR5 inhibitor on a human hepatic stellate cell line. J Cell Physiol. 2018;233(8):6224–31. https://doi.org/10.1002/jcp.26485.

    Article  CAS  PubMed  Google Scholar 

  44. Stanley TL, Feldpausch MN, Oh J, Branch KL, Lee H, Torriani M, et al. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA. 2014;312(4):380–9.

    Article  Google Scholar 

  45. Seth A, Sherman KE. Fatty liver disease in persons with HIV infection. Top Antivir Med. 2019;27(2):75–82.

    PubMed  PubMed Central  Google Scholar 

  46. Stanley TL, Fourman LT, Feldpausch MN, Purdy J, Zheng I, Pan CS, et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV. 2019;6(12):e821–30. https://doi.org/10.1016/S2352-3018(19)30338-8.

    Article  PubMed  Google Scholar 

  47. Van Welzen BJ, Mudrikova T, El Idrissi A, Hoepelman AIM, Arends JE. A Review of Non-Alcoholic Fatty Liver Disease in HIVInfected Patients: The Next Big Thing? Infect Dis Ther. 2019;8(1):33–50. https://doi.org/10.1007/s40121-018-0229-7.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Campania, Luigi Vanvitelli, Naples, Italy

    S. Martini & P. Maggi

Authors
  1. S. Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Maggi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Martini.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on HIV/AIDs

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martini, S., Maggi, P. Fatty Liver in HIV-Infected Persons. Curr Infect Dis Rep 22, 18 (2020). https://doi.org/10.1007/s11908-020-00728-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-020-00728-9

Keywords

Search

Navigation