Year: 2026
Type: book-chapter
Abstract: Antiretroviral therapy (ART) has markedly changed the clinical course of human immunodeficiency virus (HIV) infection by reducing morbidity and mortality and extending life expectancy in people living with HIV (PLWH). As HIV has become a chronic condition requiring long-term follow-up, non-AIDS-related comorbidities have become increasingly important in clinical care. Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised in PLWH at the intersection of obesity, visceral adiposity, insulin resistance, dyslipidaemia, chronic inflammation, and metabolic changes associated with ART. Within this spectrum, metabolic dysfunction-associated steatohepatitis (MASH) represents the inflammatory and potentially progressive phenotype, in which steatosis is accompanied by hepatocellular injury and a higher risk of fibrosis. Modern regimens containing integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) have been associated with weight gain, changes in fat distribution, and increased metabolic risk in some studies. However, this relationship is neither linear nor solely attributable to ART. The rebound-to-health phenomenon, discontinuation of previous weight-suppressing antiretroviral agents, host-related cardiometabolic predisposition, HIV-associated immune activation, and lifestyle factors should all be considered together. This chapter reviews the relationship between ART, weight gain, insulin resistance, and hepatic steatosis within the context of MASLD, and outlines a practical approach to screening, monitoring, and management in PLWH.
Source: IntechOpen eBooks
Authors: Çiğdem Mermutluoğlu, Mustafa Kemal Çelen
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7168758477