HIV drug treatments have transformed HIV management, extending life expectancy but introducing new health challenges like metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic steatohepatitis (NASH). As antiretroviral therapy (ART) evolves, understanding its impact on liver health becomes crucial. Explore the intricate relationship between ART, liver health, and strategies for managing these emerging risks.
Understanding the Impact of HIV Drug Treatments on NASH
HIV drug treatments have revolutionized the management of HIV, significantly reducing AIDS-related mortality and increasing life expectancy among people living with HIV (PLWH). However, as this population ages, new health challenges have emerged, particularly concerning liver health. One such challenge is the development of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), which can progress to non-alcoholic steatohepatitis (NASH) (source).
The Role of Antiretroviral Therapy (ART)
Antiretroviral therapy (ART) is essential for managing HIV, but it can also contribute to metabolic disturbances that affect liver health. The switch from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF), often combined with integrase inhibitors (INSTIs), has been linked to increased insulin resistance. This metabolic disturbance can lead to the development of metabolic syndrome, MASLD, and eventually NASH (source). Different classes of antiretroviral drugs have varying impacts on liver health. While first-generation NRTIs were associated with high mitochondrial toxicity, newer drugs like TAF and INSTIs, although less hepatotoxic, can still contribute to metabolic disorders, including weight gain and insulin resistance (source).
Risk Factors and Liver Health
Research indicates that people with HIV taking antiretroviral treatments containing integrase inhibitors or TAF are at a higher risk of developing fatty liver disease. A German study involving 319 participants with HIV found that 46% had some degree of steatosis at baseline, which increased significantly over the study period. Risk factors for developing steatosis included male sex, a body mass index (BMI) above 23 kg/m2, type 2 diabetes, and a history of low CD4 counts (source).
Managing Liver Health in PLWH
Managing liver health in PLWH requires a multidisciplinary approach. Lifestyle modifications, such as caloric restriction, a Mediterranean diet, and regular aerobic exercise, are crucial in managing MASLD. A comprehensive approach involving dietetic, psychological, and physical activity support is recommended to address these metabolic challenges effectively (source). Additionally, regular liver screening is advised for individuals with a BMI above 23 or those taking TAF or integrase inhibitors to assess liver damage (source).
Why You Should Learn More About HIV Drug Treatments and NASH Today
Understanding the effects of HIV drug treatments on liver health is crucial for improving the quality of life for people living with HIV. As the population ages, the risk of developing metabolic disorders like MASLD and NASH increases, necessitating a proactive approach to liver health management. By staying informed about the latest research and treatment strategies, healthcare providers and patients can work together to mitigate these risks and enhance overall well-being.