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Longer use of integrase inhibitors — a common HIV drug class — is tied to higher odds of severe fatty liver disease in people living with HIV. An Italian study found each additional year of use raised the risk by 19%, with obesity, high LDL, and daily alcohol compounding the danger. Experts say routine liver monitoring should be a standard part of long-term HIV care.
A new study out of Italy is raising flags about a widely used class of HIV medications. Researchers found that longer exposure to integrase strand transfer inhibitors (InSTIs) — now the backbone of most HIV treatment regimens — was independently linked to a significantly higher risk of severe liver steatosis (fatty liver disease) in people living with HIV (PLWH).
The cross-sectional study followed 265 PLWH at an outpatient HIV clinic, using non-invasive liver scans to assess steatosis and fibrosis. Nearly 30% of participants had severe steatosis, and about 9% showed significant liver fibrosis. Importantly, achieving an undetectable viral load was associated with reduced liver stiffness — a silver lining that underscores the value of viral suppression.
By the Numbers:
Why it matters: As people with HIV live longer on antiretroviral therapy, metabolic complications like fatty liver disease are becoming a growing concern. Clinicians managing long-term HIV care should consider integrating regular hepatic and metabolic monitoring — especially for patients with obesity, high LDL, or alcohol use — into routine follow-up.
