The prevalence of nonalcoholic fatty liver disease in people living with HIV: a systematic review and meta-analysis

Background Owing to long-term antiretroviral therapy (ART), the incidence of non-HIV-related chronic diseases is increasing, and liver disease is the leading cause of increased AIDS mortality. Moreover, the prevalence of NAFLD and liver fibrosis has been reported to vary widely across regions and studies. There is no precise description of the trend and characteristics of NAFLD in PLWH. Here, we aimed to explore the prevalence and outcomes of NAFLD in people living with HIV (PLWH). Methods The PubMed, Web of Science, Embase, and Cochrane Library databases were searched on August 15, 2023, for studies that evaluated the prevalence of NAFLD or liver fibrosis among PLWH. The meta-synthesized effects of NAFLD and liver fibrosis were the primary outcomes, and potential moderators were the secondary outcomes. The meta-analysis of the combined event rate (ER) and random effects was conducted on the basis of the number of individuals with NAFLD, the number of individuals with liver fibrosis, and the total sample size. Results Of the 3520 studies identified, 41 studies were eligible for the meta-analysis. The results revealed that the combined ERs of NAFLD and liver fibrosis were 0.38 (95% CI: 0.33-0.43, p < 0.01) and 0.25 (95% CI: 0.18-0.32, p < 0.01), respectively. Conclusions This meta-analysis provided empirical evidence that the prevalence of NAFLD and liver fibrosis in PLWH is greater than that in the general population, which requires sufficient attention. In the HIV population, noninvasive imaging to monitor NAFLD changes should be strengthened, and a high TG level might be an early predictive indicator for HIV-associated fatty liver disease; however, large-scale prospective clinical research data are still needed for further validation and evaluation.