There are limited data regarding the clinical, biochemical and liver histological characteristics of patients with HIV‐associated nonalcoholic fatty liver disease (NAFLD), and whether this entity differs in presentation and severity from primary NAFLD

To examine the clinical and histological differences between HIV‐associated NAFLD and primary NAFLD.

This is a cross‐sectional, case–control study comparing patients with HIV‐associated NAFLD vs. patients with primary NAFLD. HIV‐infected patients were identified from a database of consecutive liver biopsies performed at the University of California at San Diego, over a 13‐year period. HIV‐infected patients with biopsy‐proven NAFLD were selected as cases, after exclusion of other causes of liver disease and hepatic steatosis. Age–sex‐matched controls with biopsy‐proven primary NAFLD were randomly identified from the same pathology database. All biopsies underwent a standardised, detailed, histological research evaluation by a liver pathologist who was blinded to clinical and case–control status.

Compared to age–sex‐matched patients with primary NAFLD (n = 33), patients with HIV‐associated NAFLD (n = 33) had significantly higher mean aspartate aminotransferase (P < 0.001), alanine aminotransferase (P < 0.001), alkaline phosphatase (P = 0.003) and serum triglycerides (P = 0.024). Similarly, compared to age–sex‐matched primary NAFLD, patients with HIV‐associated NAFLD had significantly higher rates of definite steatohepatitis (37% vs. 63%, P = 0.04), and more features of liver injury, including lobular inflammation (<0.001) and acidophil bodies (<0.001).

Compared to age–sex‐matched primary NAFLD, HIV‐associated NAFLD has increased severity of liver disease and a higher prevalence of NASH.