Liver Disease Epidemiology in HIV-Infected Populations

Liver disease has emerged as a leading non-AIDS-related cause of morbidity and mortality in people living with HIV. In the era of effective antiretroviral therapy (ART), increased life expectancy has unmasked a spectrum of hepatic complications spanning steatosis, non-alcoholic steatohepatitis, progressive fibrosis and cirrhosis. Coinfection with hepatitis B or C viruses remains an important driver of accelerated fibrosis in many regions, yet metabolic factors such as obesity, insulin resistance and dyslipidaemia are now recognised as major contributors even in monoinfected cohorts. Persistent immune activation, direct viral effects and long-term ART toxicities each play a role in hepatocyte injury. Non-invasive tools such as transient elastography and serological biomarkers have facilitated large-scale screening for steatosis and fibrosis, revealing a global prevalence of liver abnormalities of 20–40% among HIV populations. Variations in epidemiology reflect differing access to diagnostics, prevalence of co-infections and ART regimens. The growing burden of liver disease underscores the need for integrated management strategies that address viral suppression, metabolic risk reduction and early detection of hepatic injury to prevent end-stage liver outcomes.

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Liver Disease Epidemiology in HIV-Infected Populations publication trend

The graph below shows the total number of articles in liver disease epidemiology in hiv-infected populations across all publications each year (not limited to Nature Index journals).

Technical terms

Cirrhosis: Advanced stage of liver fibrosis characterised by extensive scar formation and architectural distortion, impairing hepatic function.

Steatosis: Accumulation of triglycerides within hepatocytes, often representing the first stage of non-alcoholic fatty liver disease.

Transient elastography: Ultrasound-based technique that measures liver stiffness as a surrogate for the degree of fibrosis, commonly marketed as FibroScan.

Controlled attenuation parameter (CAP): Quantitative measure of ultrasound attenuation during transient elastography, reflecting the degree of hepatic fat infiltration.

Antiretroviral therapy (ART): Combination of drugs targeting different stages of the HIV life cycle to suppress viral replication and preserve immune function.

References

1. PBMCs gene expression signature of advanced cirrhosis with high risk for clinically significant portal hypertension in HIV/HCV coinfected patients: A cross-control study. Biomedicine & Pharmacotherapy (2023).
2. Stratifying the risk of NAFLD in patients with HIV under combination antiretroviral therapy (cART). EClinicalMedicine (2021).
3. Screening for nonalcoholic steatohepatitis by using cytokeratin 18 and transient elastography in HIV mono-infection. PLOS ONE (2018).