skip to main content

NAFLD in Treated HIV — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHIV MedicineNAFLD in Treated HIVSCE Infectious Diseases

A 40-year-old man with HIV (CD4 620, VL <50 on ART for 10 years) develops non-alcoholic fatty liver disease with steatohepatitis. He has gained 22 kg since starting ART (now BMI 33). His ART is BIC/TAF/FTC. What is the relationship between his ART and NAFLD?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — INSTI-associated weight gain (especially BIC and DTG, augmented by TAF) is a contributing factor to metabolic syndrome and NAFLD in treated HIV

NAFLD/NASH is increasingly recognised in the treated HIV population. INSTI-associated weight gain (particularly with Dolutegravir and Bictegravir, augmented by TAF vs TDF) contributes to metabolic syndrome, insulin resistance, and hepatic steatosis. HIV itself (chronic inflammation, gut microbial translocation) also independently contributes to liver fibrosis. Management follows standard NAFLD guidelines: weight loss, exercise, metabolic risk factor management. ART switch may be considered for severe metabolic complications but is not routinely recommended solely for weight management per BHIVA 2025.

Reference: BHIVA 2025 – ART guidelines (metabolic section); EASL 2024 – NAFLD; EACS 2025