Non-alcoholic fatty liver disease (NAFLD) is an umbrella term for a range of liver conditions caused by a build-up of fat in the liver. It is defined by the accumulation of fat in the liver and the presence of triglycerides (a type of fat) in liver cells, without there being another cause such as excess alcohol consumption. NAFLD is increasingly common around the world, especially in Western countries. It occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. NAFLD can not only lead to liver problems, including fibrosis (scarring of the liver), but also to changes in the body’s metabolism, such as atherosclerosis (hardening of the arteries).

Until now, much of the liver disease occurring in people living with HIV has been associated with co-infection with hepatitis B or C, but NAFLD is emerging as a new concern for people who do not have hepatitis B or C.

A group of UK researchers have recently conducted a review of existing studies on NAFLD in people living with HIV who do not also have hepatitis B or C. They estimate that around one third of people with HIV may have NAFLD – a higher rate than seen in the general population.

Looking into risk factors for NAFLD in people living with HIV, they found that people are at increased risk of it if they are overweight or obese (especially with a lot of fat around the waist), have type 2 diabetes, high fasting glucose levels, high blood pressure, high total cholesterol, low HDL cholesterol, high LDL cholesterol, or high levels of the liver enzymes ALT and AST. Many of these risk factors are the same as in the general population. But the study highlights the link between raised levels of liver enzymes and NAFLD. Experts say that doctors should properly investigate persistently raised levels of liver enzymes, considering NAFLD as a possible cause.

It is important that NAFLD is diagnosed promptly so that lifestyle changes can be made in good time. While effective drug treatments for NAFLD are not yet available, the researchers call for people with HIV to be included in clinical trials for new drug treatments.

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