A NEW randomised controlled trial has shown that a dietitian-led lifestyle modification programme can significantly improve liver health in people living with HIV who have metabolic dysfunction-associated steatotic liver disease (MASLD).
Conducted at the Prince of Wales Hospital in Hong Kong, the study focused on individuals aged 18 and older who were on stable antiretroviral therapy and had controlled HIV viral loads.
Participants were randomly assigned to receive either standard care or a structured, dietitian-led lifestyle programme over 12 months. All had been diagnosed with MASLD, defined by at least 5% intrahepatic triglyceride content, as measured by advanced imaging techniques. The main goal was to see how many participants could achieve resolution of MASLD, defined as liver fat levels dropping below the 5% threshold after one year.
Of the 203 people screened, 84 were enrolled in the trial, 43 in the intervention group and 41 in the control group. The majority of participants were male (88%), and 78 completed the full 12-month intervention. The results showed that 28% of those in the lifestyle programme achieved MASLD resolution, compared with only 10% in the standard care group. This difference, adjusted for diabetes status at baseline, was statistically significant.
Importantly, the intervention was well tolerated, with no deaths reported and only one serious adverse event, which occurred in the control group and was unrelated to the study. Minor adverse events occurred at similar rates across both groups and were mostly mild in severity.
The findings highlight the potential for behavioural strategies, such as dietitian-led interventions, to play a key role in managing liver health in people with HIV. With no effective pharmacological treatments currently approved for MASLD, especially in the context of HIV, this approach may offer a practical and accessible way to reduce liver fat and improve broader metabolic outcomes in this vulnerable population.
Reference
Li G et al. Lifestyle modification programme for people living with HIV with metabolic dysfunction-associated steatotic liver disease: a randomised controlled trial. Lancet HIV. 2025;12(6):e416-e427.
