Nutritional and Lifestyle Therapy for NAFLD in People with HIV

• Published in: Nutrients 2023-04, Vol.15 (8), p.1990
• Main Authors: Cinque, Felice, Cespiati, Annalisa, Lombardi, Rosa, Guaraldi, Giovanni, Sebastiani, Giada
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral therapy; Antiviral agents; Behavior modification; Beverages; Carbohydrates; Care and treatment; Clinical trials; Comorbidity; Development and progression; Diet therapy; Dietary intake; Drug therapy; Epidemics; Fatty liver; Fibrosis; Food and nutrition; Food security; Fructose; Health aspects; Hepatocellular carcinoma; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV infection; HIV Infections - complications; HIV Infections - therapy; HIV patients; Human immunodeficiency virus; Humans; Insulin resistance; Intestinal microflora; Life Style; lifestyle; Liver; Liver diseases; MAFLD; Methods; NAFLD therapy; Non-alcoholic Fatty Liver Disease; Nutrients; Nutrition; Nutritional Status; Obesity - metabolism; Review; Risk factors; Saturated fatty acids; Type 2 diabetes
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu15081990

HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.