Steven Grinspoon, MD, on Mechanisms and Treatments of Steatosis in HIV

In this video, Steven Grinspoon, MD, talks about his session Mechanisms and Treatments of Steatosis in HIV at the Conference on Retroviruses and Opportunistic Infections 2021, including the reasons why fatty liver disease is an increasing problem for patients with HIV.

Additional Resource: 

Steven K. Grinspoon, MD, is a professor of medicine and director of the Nutrition Obesity Research Center at Harvard Medical School in Boston, Massachusetts. He is also the chief of the Metabolism Unit and the MGH Endowed Chair in Neuroendocrinology and Metabolism at Massachusetts General Hospital in Boston, Massachusetts. 


Dr Steven Grinspoon:  I'm Dr. Steven Grinspoon. I'm a professor of medicine at Harvard Medical School. I'm Chief of the Metabolism Unit at MGH, and I've had a longstanding interest in metabolic complications of HIV, including fatty liver disease.

Fatty liver disease is becoming an increasing problem for HIV‑infected patients, particularly as it relates so strongly to obesity and weight gain and increased visceral adiposity. As you know, HIV‑infected patients may be prone to that on chronic ART, and also, they may be prone to insulin resistance and diabetes that also travel with fatty liver disease.

One of the concerns is that there is a higher prevalence of fatty liver disease in HIV, and that seems to be true. Some preliminary data suggest about 35 percent of HIV‑infected patients or people with HIV get fatty liver disease versus maybe a smaller number, 20, 25 percent in the general population.

What are the consequences of that? There are a number of consequences. People with fatty liver disease in the blandest forms have simply too much fat in their liver, but that can progress over time to increased inflammation in the liver, increased fibrosis, ultimately cirrhosis, and even cancer of the liver.

It's important to understand it's the beginning of a process and it's often associated with inflammation and varying degrees of cirrhosis. That fat may begin a noxious process in the liver that is important to the health of patients.

It's also important because fatty liver disease is an independent predictor of cardiovascular disease. Patients with fatty liver disease have a 70 percent higher risk of cardiovascular disease than without fatty liver disease, controlling for traditional cardiovascular risk factors.

It's prevalent. It may lead to other complications. It's associated with cardiovascular disease. It presents with a different phenotype in HIV patients that may present at a lower weight. It also is associated with more inflammation in HIV.

There are a number of different strategies, which we'll talk about, that are aiming to target that in HIV. It's an important public health concern that needs to be addressed.

I'd like to thank the audience who are watching this and for the people who participated in the symposium. Thank you so much.