Unraveling the Link Between Food Insecurity and Liver Health in People with HIV

By A.J. Hostetler

World Aids Day graphicIn a groundbreaking study, researchers delved into the impact of food insecurity on liver health among individuals living with HIV, shedding light on the complex interplay between nutritional access and liver diseases.

As the United States grapples with the escalating challenge of food insecurity—the limited or uncertain access to nutritionally adequate foods—a new frontier in public health research has emerged. Recent research has shown that food insecurity is a risk factor for metabolic dysfunction-associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease).

Despite this growing awareness, little is known about the specific impact of food insecurity on liver diseases in individuals living with HIV, the virus that causes AIDS. To learn more, a diverse group of 570 adults being treated with antiretroviral therapy for HIV participated in a comprehensive study, funded by the National Institutes of Health, and conducted at eight U.S. centers, including VCU Health. The participants did not have viral hepatitis or other liver disease, and all had scans conducted for steatotic, or fatty, liver disease and fibrosis, or scarred liver tissue.

In an abstract presented at the recent meeting of the American Association for the Study of Liver Diseases, the researchers report that steatotic liver disease was found in in 54% of the individuals, while 8% showed signs of advanced fibrosis. Notably, 31% of the group reported experiencing food insecurity, with higher percentages among those with steatotic liver disease (27%) and advanced fibrosis (47%).

The study's conclusion underscores the prevalence of food insecurity among adults with HIV and its association with liver health, according to one of the researchers, Richard Sterling, M.D., M.Sc., Professor of Medicine, Chief of Hepatology, Chief Clinical officer for the institute and director of HIV-Liver Disease at VCU. Strikingly, while food insecurity appears to lower the risk of steatotic liver disease, it paradoxically heightens the risk of advanced fibrosis.

The researchers suggest that food insecurity may contribute to fibrosis through mechanisms beyond the build-up of fat in the liver, or steatosis.

This work examining the intricate interplay between health, socioeconomic factors and food security, may open avenues for targeted interventions to improve both nutritional access and liver health for vulnerable individuals living with HIV.