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Liver disease in women with HIV

Andrea R Amaro1, Hayk Darbinyan2, Ani Kardashian1

  • 1Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles.

Current Opinion in HIV and AIDS
|November 4, 2025
PubMed

Insights

Women with HIV (WWH) face unique liver disease challenges. Metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-related liver disease are increasingly common, necessitating targeted interventions.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Endocrinology

Background:

  • Chronic liver disease is a primary non-HIV mortality cause in women with HIV (WWH).
  • Antiretroviral therapy (ART) has shifted disease prevalence from viral hepatitis to alcohol-associated liver disease and metabolic dysfunction associated steatotic liver disease (MASLD).
  • WWH experience unique risks including social marginalization, biological sex differences, and HIV infection impacting liver health.

Purpose of the Study:

  • To review the pathophysiology, natural history, and management of liver injury in WWH.
  • To explore the role of viral, pharmacologic, and sex hormone-related factors in liver disease progression.
  • To identify challenges and future research needs for improving liver health in WWH.

Main Methods:

  • Literature review of pathophysiology, natural history, and management of liver diseases in WWH.
  • Analysis of factors contributing to accelerated fibrogenesis and hepatic steatosis.
  • Examination of the impact of menopausal transition and HIV-associated estrogen deficiency.

Main Results:

  • MASLD and alcohol-associated liver disease are now more prevalent than viral hepatitis-related liver disease in WWH on ART.
  • Accelerated fibrogenesis in WWH involves HIV, ART, impaired gut barrier, and microbiome alterations.
  • Menopausal transition exacerbates a profibrogenic state in WWH due to estrogen deficiency; GLP-1 agonists show promise for MASLD.

Conclusions:

  • WWH face distinct obstacles in liver disease care, influenced by social, biological, and HIV-specific factors.
  • Further research is crucial to understand mechanisms and develop interventions for better liver health outcomes in WWH.
  • Addressing social marginalization and biological sex differences is key to improving care for this population.
Abstract

Keywords:
alcohol-associated liver diseasemenopausemetabolic dysfunction associated steatotic liver diseasesex differencessocial determinants of healthviral hepatitiswomen with HIV

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