Case 26. A Weighty Challenge: Elevated Liver Enzymes
Download MP3A 41-yr-old man with HIV for 15 years, suppressed on ART, has had elevated liver enzymes for several years. Listen as Chris Hoffmann and Juhi Moon from Hopkins review the differential diagnosis and diagnostic and management approaches with a focus on metabolic dysfunction associated steatotic liver disease.
References:
References:
- Bril F. Metabolic liver disease: A summary of major guidelines and identifying opportunities to improve future guidelines. Diabetes Obes Metab. 2026;28 Suppl 2(Suppl 2):63-80. PMID: 41821514.
- Cinque F, Saeed S, Farina F, et al. FIB-4 fails to identify significant liver fibrosis in people with HIV: A large multinational screening study. Hepatology. Published online May 1, 2026. PMID: 42065895.
- Eckard AR, Wu Q, Sattar A, et al. Once-weekly semaglutide in people with HIV-associated lipohypertrophy: a randomised, double-blind, placebo-controlled phase 2b single-centre clinical trial. Lancet Diabetes Endocrinol. 2024;12(8):523-534. PMID: 38964353.
- European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Obes Facts. 2024;17(4):374-444. PMID: 38852583.
- Harrison SA, Taub R, Neff GW, et al. Resmetirom for nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled phase 3 trial. Nat Med. 2023;29(11):2919-2928. PMID: 37845512.
- Horberg M, Thompson M, Agwu A, et al. Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. Published online October 12, 2024. PMID: 39393187.
- Lake JE, Kitch DW, Kantor A, et al. The Effect of Open-Label Semaglutide on Metabolic Dysfunction-Associated Steatotic Liver Disease in People With HIV. Ann Intern Med. 2024;177(6):835-838. PMID: 38684100.
- Medeiros DG, Ferreira LF, Lamp JDS, Telles da Rosa LH. The impact of resistance training in patients diagnosed with metabolic dysfunction-associated steatotic liver disease: a systematic review. Eur J Gastroenterol Hepatol. 2025;37(2):129-136. PMID: 39589803.
- Roen AO, Peters L, Wandeler G, et al. Chronic Liver Enzyme Elevation and Use of Contemporary ARVs Among People With HIV. Open Forum Infect Dis. 2024;11(6):ofae308. Published 2024 Jun 8. PMID: 38919512.
- Sanyal AJ, Newsome PN, Kliers I, et al. Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. N Engl J Med. 2025;392(21):2089-2099. PMID: 40305708.
- Sterling RK, Duarte-Rojo A, Patel K, et al. AASLD Practice Guideline on imaging-based noninvasive liver disease assessment of hepatic fibrosis and steatosis. Hepatology. 2025;81(2):672-724. PMID: 38489518
- Wohl DA, Koethe JR, Sax PE, et al. Antiretrovirals and Weight Change: Weighing the Evidence. Clin Infect Dis. 2024;79(4):999-1005. PMID: 38606799.
- Wood S, Won SH, Hsieh HC, et al. Risk Factors Associated With Chronic Liver Enzyme Elevation in Persons With HIV Without Hepatitis B or C Coinfection in the Combination Antiretroviral Therapy Era. Open Forum Infect Dis. 2021 Feb 24;8(3):ofab076. PMID: 33738323.
Related Guidelines and Resources:
- AASLD: AASLD Practice Guideline on imaging-based noninvasive liver disease assessments of hepatic fibrosis and steatosis
- EASL: EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)
- NYSDOH AI Clinical Guidelines Program: Primary Care for Adults With HIV
- Viremic—Cases in HIV: Case 10. A Growing Problem: ART-Associated Weight Gain
