TOPLINE:
A significant majority of HIV care providers are screening for nonalcoholic fatty liver disease (NAFLD) in patients with HIV (PWH). However, barriers such as uncertainty about tests, limited diagnostic tools, and resource constraints remain major hurdles.
METHODOLOGY:
A comprehensive study involved an anonymous survey of HIV providers affiliated with the American Academy of HIV Medicine. Sent out over six weeks in early 2023, the survey aimed to understand current practices and identify gaps.
The 16-question online poll included assessments of referral and screening practices, barriers to NAFLD screening, and attitudes toward potential support tools for diagnosis and management.
A total of 214 respondents participated, with the majority being physicians, nurse practitioners, and physician assistants, and most having over a decade of experience.
TAKEAWAY:
The survey found that primary care practitioners, particularly those in family practice, internal medicine, and infectious diseases, are leading the charge. These practitioners are increasingly aware of the importance of NAFLD screening in HIV-positive patients.
Two-thirds of participants reported screening PWH for NAFLD. Key triggers for screening were elevated liver enzymes, metabolic syndrome, obesity, and prediabetes/diabetes.
When it comes to screening methods, liver enzyme tests and abdominal ultrasounds were preferred. Advanced techniques like vibration-controlled transient elastography and MRI were used less frequently.
Despite progress, 64% of providers identified barriers to NAFLD screening. Uncertainty about which tests to order and concerns about sufficient diagnostic data were the most common challenges.
IN PRACTICE:
The findings emphasize the need for tailored clinical guidelines for HIV providers addressing NAFLD. Improved education for PWH and inclusion in therapeutic trials are also essential steps.
LIMITATIONS:
The study was limited by not assessing providers’ awareness of existing American Association for the Study of Liver Diseases guidance on NAFLD.
DISCLOSURES:
This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Some authors reported receiving research grants, consulting fees, and stock equity from various pharmaceutical companies.
The Urgency of Addressing NAFLD in PWH
The prevalence of nonalcoholic fatty liver disease (NAFLD) among people with HIV is on the rise. Given that both conditions often coexist, effectively managing one can significantly impact the other’s progression.
Primary care providers play a pivotal role in ensuring early detection and intervention. By incorporating NAFLD screening into routine HIV care, providers can better manage overall health outcomes for their patients.
Overcoming the Barriers
The barriers highlighted in the study—uncertainty in test selection and insufficient diagnostic data—suggest a need for clearer guidelines. Health organizations should develop detailed protocols to facilitate informed decision-making.
Education is another critical component. Providing PWH with comprehensive information about NAFLD and its links to HIV can empower them to take proactive steps in their care.
Incorporating PWH into research initiatives for novel treatments could also help expand the knowledge base on NAFLD management in this patient population.
Conclusion
In summary, while many HIV care providers are making strides in NAFLD screening, there is room for improvement. By addressing the identified barriers and fostering a comprehensive approach to patient education and research, healthcare providers can enhance the quality of life for patients with both conditions.
As the field advances, tailored clinical guidelines and integrated care models will be crucial. Continuous support and education for both providers and patients will be key to successfully managing NAFLD in the context of HIV.
We encourage healthcare professionals and patients alike to engage with the ongoing conversation and share insights to further advance this field.
Take Action Today
We invite you to share your thoughts and experiences with NAFLD screening in HIV patients. Join the conversation below and help us spread awareness about this important topic.
Comments:
Leave your comments below to share your insights and engage with our community.
Subscribe to our newsletter to stay updated on the latest health insights and news.
Share this article on social media to help raise awareness and start important conversations.