ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is a frequent aging-related comorbidity, affecting 35% of HIV mono-infected patients. Few studies investigated the natural history of NAFLD in the setting of HIV infection, and all of them are based on noninvasive diagnostic modalities rather than liver histology. Several noninvasive tools for the diagnosis of hepatic steatosis and fibrosis have been extensively studies in NAFLD. Lifestyle modifications are the cornerstone of treatment for NAFLD, while limited pharmacologic options are available for patients with significant liver fibrosis. Bariatric surgery is an option for durable weight loss in obese NAFLD patients, with significant improvement in both associated metabolic syndrome comorbidities and liver fibrosis. The pathogenesis of NAFLD in people with HIV encompasses multiple complex mechanisms, including frequent metabolic pathogenic factors and risk factors specific to HIV infection. These mechanisms are only partially understood and include comorbid metabolic conditions, direct viral effects and adverse effects of antiretroviral therapy.
