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  Fatty Liver Disease

Long Term Outcomes: Mortality and Causes of Death in NAFLD
  "the most important cause of death in people with NAFLD.....is the most common cause of death in people with NAFLD.....there is an association, causation is not completely determined"
Mary Rinella MD Mar 18, 2017;
From Jules: Slide presentation follows this section just below on HIV and fatty liver, which gets little to no attention. Metabolic syndrome, HIV and some older nukes likely play a role in fatty liver in HIV. But clinicians do not evaluate PWHIV for fatty liver or NASH, In the slide presentation you will see Mary Rinella says elevated ALTs may indicate fatty liver presence and in the 2nd study below from EACS they report 20% of HIV+ had non-viral liver disease measured by liver stiffness of whom 50% had hepatic steatosis & 20% had cirrhosis
Fatty Liver in HIV - NATAP Section dedicated to Fatty Liver
IAS: Fatty Liver in HIV+ at IAS - (08/05/17)
EACS: Non-viral Liver Disease Burden in HIV Mono-infected Individuals: A Prospective Cohort Study - (12/07/17)
Changes in Liver Fibrosis and Steatosis in HIV Mono-Infected patients over 24 months - 50% have fatty liver at average age of 46 - (03/28/17) "Significant fibrosis and hepatic steatosis are highly prevalent among HIV mono infected patients.At baseline 41% of the patients had significant steatosis (CAP > 238 dB/m) vs. 54% of the patients after 24 months (p = 0.023)....our data suggest that hiv might directlyinfluence hepatic fibrogenesis. Hepatic steatostis might be triggered by metabolic factors & uncontrolled HIV infection"
Increased fat accumulation in the liver in HIV-infected patients with antiretroviral therapy-associated lipodystrophy......http://www.natap.org/2002/Dec/120202_3.htm
CROI: FATTY LIVER DISEASE: A GROWING CONCERN - - (04/12/17) a plenary talk by noted fatty liver expert Rohit Loomba from UCSD
CROI/2017: LIVER STEATOSIS AND FIBROSIS IN AT-RISK EUROPEAN HIV-MONOINFECTED PATIENTS - 64% with steatosis among those who had elevated LFTs and/or metabolic syndrome and/or lipodystrophy- (03/28/17)
IAS: Metabolic syndrome and obesity are the cornerstones of liver fibrosis in HIV-monoinfected patients: results of the METAFIB study - (07/25/17) see table 25% of HIV+ [without hepatitis] with Metabolic Syndrome have liver fibrosis as measured by Fibroscan >7.1kPA, 15% with >8.7 kPA and 7% with > 10.3 kPA
Hepatic steatosis progresses faster in HIV mono-infected than HIV/HCV co-infected patients and is associated with liver fibrosis - (05/22/17)
IAS: Predictor factors associated with liver fibrosis and steatosis by transient elastography in HIV mono-infected patients under long-term combined antiretroviral therapy - (07/26/17)


Its estimated 30-40% of HIV+ have fatty liver (NAFLD) and studies suggest these rates may be higher than in HIV-negatives. BUT here is a study finding 67% fatty liver in HCV/HIV coinfected .....67% Steatosis in HCV/HIV Coinfected: : Liver inflammation, HCV genotype 3, and BMI are associated with steatosis, a common finding in HCV-HIV-coinfected patients http://www.natap.org/2007/HIV/062007_02.htm