icon-folder.gif   Conference Reports for NATAP  
  The International Liver Congress™
EASL - European Association for the
Study of the Liver
2019 April 10-14
Vienna Austria
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EASL Wrap-up session: Metabolic and alcohol related liver disease, Fatty Liver/NASH
  Fabio Marra
Dipartimento di Medicina Sperimentale
e Clinica
University of Florence, Italy
WEBCAST: https://easl.meta-dcr.com/ilc2019/crs/metabolic-and-alcohol-related-liver-disease
Reported by Jules Levin
EASL 2019 April 14 Vienna
Pdf f slide talk attached
NATAP Fatty Liver website / Fatty Liver, NASH, NAFLD
HIV+ have higher rates of fatty liver than HIV-negatives
HIV clinicians are not considering the possibility that patients could have fatty liver from Jules: the main concern is that fatty liver [steatosis] can lead to advanced liver disease [without having HCV, HBV or excessive alcohol consumption]....metabolic syndrome & history use of certain ARTs can increase fatty liver and risk for developing liver disease, Fibroscan is used to evaluate liver disease (LSM) & fatty liver (CAP score). HIV+ have higher rates of fatty liver than HIV-negatives. It's estimated that fatty liver is present in from 35-65% of HIV-infected
Fatty Liver in HIV+ at IAS - (08/05/17)
Its estimated 20-30% of the general population has fatty liver (NAFLD: non-alcoholic fatty liver disease), but among HIV+ the rates are higher, an estimated 30-40% with some studies finding higher rates of 50-60%, it depends on the characteristics if the HIV+ patients in the study. History of use of the old nukes - d4T, AZT etc - have been found to contribute to fatty liver. Fatty liver is an accumulation of lipids in the liver which over many years can lead to cirrhosis & severe liver disease, and fatty liver can develop without having HCV or HBV. Mitochondrial toxicity which is associated with HIV & some ARTs may contribute additionally to fatty liver in HIV+. . Lipid abnormalities & metabolic abnormalities as we see in HIV can contribute to fatty liver. Fatty liver goes mostly unrecognized and receives little attention from primary care doctors. Unfortunately HIV clinicians and primary care doctors are not very familiar with fatty liver so it rarely gets evaluated. Elevated liver enzymes can mean one has fatty liver, but all too often primary care doctors including HIV clinicians do not pay attention to these elevations, they do not equate these ALT/AST elevations with the possibility that a patient may have fatty liver, they assume the elevated liver enzymes are merely caused by HIV or ARTs which intact they may be but the person may also have fatty liver, which as I mentioned can over many years develop into cirrhosis and severe liver disease. It is only recently getting attention, FATTY LIVER, in the HIV world, at CROI 2017 was a plenary talk by Rohit Loomba linked to below showing the raised concern about fatty liver. The ACTG is beginning to discuss fatty liver and design studies.
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