Liver disease is common among patients infected with HIV. The proportion of deaths caused by liver-related aetiologies has increased between 8 to 10-fold in the post-antiretroviral therapy (ART) era while AIDS-related mortality has fallen more than 90-fold.
NAFLD is an important contributor to this trend. Higher rates of the disease are reported in HIV-infected patients, ranging from 7.3% to 57.1%. This is likely due to both high frequency of metabolic conditions underlying the pathogenesis of NASH and ART-related hepatotoxicity.
Despite the disease burden, there are no proven treatments to reduce HIV-associated NASH. Vitamin E treatment seems safe and leads to rapid and sustained normalization of Alanine aminotransferase and reduction of hepatic steatosis in a significant number of HIV mono-infected patients with a non-invasive diagnosis of NASH.