Garrido NJ, Suárez M, Mateo J. Steatotic liver disease in people with human immunodeficiency virus: A narrative review of metabolic steatotic liver disorders. World J Hepatol 2026; 18(5): 117567 [DOI: 10.4254/wjh.v18.i5.117567]
Corresponding Author of This Article
Miguel Suárez, MD, PhD, Associate Chief Physician, Department of Gastroenterology, Virgen de la Luz Hospital, Hermandad Donantes De Sangre, Cuenca 16002, Castille-La Mancha, Spain. msuarezmatias@sescam.jccm.es
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Gastroenterology & Hepatology
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Review
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Garrido NJ, Suárez M, Mateo J. Steatotic liver disease in people with human immunodeficiency virus: A narrative review of metabolic steatotic liver disorders. World J Hepatol 2026; 18(5): 117567 [DOI: 10.4254/wjh.v18.i5.117567]
World J Hepatol. May 27, 2026; 18(5): 117567 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.117567
Steatotic liver disease in people with human immunodeficiency virus: A narrative review of metabolic steatotic liver disorders
Nicolás Jesús Garrido, Miguel Suárez, Jorge Mateo
Nicolás Jesús Garrido, Department of Internal Medicine, Virgen de la Luz Hospital, Cuenca 16002, Castille-La Mancha, Spain
Nicolás Jesús Garrido, Miguel Suárez, Jorge Mateo, Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca 16071, Castille-La Mancha, Spain
Nicolás Jesús Garrido, Miguel Suárez, Jorge Mateo, Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo 45071, Castille-La Mancha, Spain
Miguel Suárez, Department of Gastroenterology, Virgen de la Luz Hospital, Cuenca 16002, Castille-La Mancha, Spain
Author contributions: Garrido NJ, Suárez M, and Mateo J participated in the design, editing, data collection of the manuscript, the review of the literature and writing; and all authors have reviewed and approved the paper.
AI contribution statement: The article was originally written in our native language and subsequently translated into English. In some of the more technical paragraphs, ChatGPT was used solely to assist with grammatical revision and to improve the overall quality of the language. It was also used to review the abstract and core tip, with the aim of enhancing clarity and reader engagement. No sections of the manuscript were generated using AI. It was used solely to improve the readability and overall appeal of the abstract.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Miguel Suárez, MD, PhD, Associate Chief Physician, Department of Gastroenterology, Virgen de la Luz Hospital, Hermandad Donantes De Sangre, Cuenca 16002, Castille-La Mancha, Spain. msuarezmatias@sescam.jccm.es
Received: December 10, 2025 Revised: January 12, 2026 Accepted: March 5, 2026 Published online: May 27, 2026 Processing time: 167 Days and 7.6 Hours
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are increasingly recognized as relevant comorbidities among people living with human immunodeficiency virus (PLWH), even in the absence of viral hepatitis coinfection or significant alcohol consumption. As life expectancy in PLWH improves, the burden of metabolic complications has become a major clinical concern. This narrative review explores the key risk factors implicated in the development of MASLD and MASH in this population, highlighting the complex interplay between traditional metabolic disturbances, chronic human immunodeficiency virus-related inflammation, long-term antiretroviral therapy, and genetic susceptibility. Obesity, type 2 diabetes, and aging remain central contributors, while exposure to certain antiretroviral therapy agents, particularly older thymidine analogues, is associated with higher hepatic risk. In contrast, newer regimens, including integrase strand transfer inhibitors and combinations such as tenofovir disoproxil fumarate with rilpivirine, may offer metabolic or hepatic benefits. Genetic variants such as PNPLA3 and TM6SF2 further influence disease progression. The use of non-invasive diagnostic tools combining serum biomarkers and imaging techniques has shown promising utility in clinical practice. A comprehensive and individualized approach to risk stratification and management is essential to improve liver-related outcomes in PLWH and to mitigate the growing impact of MASLD and MASH in this vulnerable population.
Core Tip: Metabolic dysfunction-associated steatotic liver disease and steatohepatitis are increasingly prevalent in people living with human immunodeficiency virus, even in the absence of viral hepatitis or significant alcohol intake. This article summarizes current evidence on epidemiology, pathophysiology, and key risk factors, highlighting the interplay between chronic human immunodeficiency virus-related inflammation, antiretroviral therapy-induced metabolic changes, genetic susceptibility, and traditional cardiometabolic risk factors. We also discuss the clinical utility of non-invasive diagnostic tools and propose a practical, risk-adapted approach to screening and management aimed at improving liver-related outcomes in this growing and vulnerable population.
