Lifestyle Modification Programme for HIV-infected Individuals With Fatty Liver

Lifestyle Modification Programme for HIV-infected Individuals With Non-alcoholic Fatty Liver Disease: A Randomized Controlled Trial

Non-alcoholic fatty liver disease (NAFLD) is rising in prevalence, and will likely become the predominant cause of chronic liver disease in HIV-infected individuals. Metabolic factors and obesity are important risk factors for NAFLD in HIV-infected individuals. There is currently no approved effective pharmacological treatment for fatty liver disease. Therefore, lifestyle modification directing at weight loss is currently the cornerstone of treatment for fatty liver disease in the general population. Hypocaloric diets can improve fatty liver in the general population, but the most effective specific dietary interventions are yet to be elucidated. The study aims to 1. determine the efficacy of a lifestyle modification programme in inducing resolution of NAFLD in HIV-infected individuals 2. to determine the efficacy of a lifestyle modification programme in improving insulin resistance, pro-inflammatory markers, and liver fibrosis in HIV-infected individuals with fatty liver disease 3. to determine changes in intestinal microbiome secondary to the lifestyle modification programme, and the association with resolution of NAFLD in this group of patients.

The dietary intervention program will be scheduled for 12 months, and conducted by a dietitian.The program aims to increase energy expenditure and reduce caloric intake, with an emphasis on long-term lifestyle and behavioural change. An exercise instructor will provide advice on physical activity. A mobile tracking device to monitor calories expenditure will be provided to each participant during they study period to encourage physical activity.

The program consists of education on glycemic index, balanced diet, interpretation of food labels, food exchanges, healthy eating out techniques and healthy cooking methods.

The primary endpoint is the proportion of patients with resolution of NAFLD as determined by proton-magnetic resonance spectroscopy at month 12.

Partial resolution of NAFLD is defined as absolute reduction of hepatic triglyceride content by 30% or more.

The proportion of patients with insulin resistance (estimated by the homeostasis model) will be determined

Inclusion Criteria: age 18 years or above positive HIV antibody, on anti-retroviral therapy HIV viral load ≤50 copies/mL for ≥6 months intrahepatic triglyceride content ≥5% on magnetic resonance spectroscopy Exclusion Criteria: current AIDS-defining illness active malignancy, or history of malignancy within the last 5 years hepatitis B and/or hepatitis C co-infection, as determined by positive HBsAg and anti--HCV antibody alcohol consumption >30g per week in men or 20g per week in women alanine aminotransferase (ALT) above 10 times the upper limit of normal liver decompensation (as evidenced by bilirubin above 50 µmol/l, platelet count below 100 × 109/l, prothrombin time above 1.3 times the upper limit of normal, albumin below 35 g/l, presence of ascites or varices).