More than a third of people living with HIV have fatty liver disease, and a substantial number have moderate or worse fibrosis, according to a recent study in Germany. Non-alcoholic fatty liver disease (NAFLD) and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for a growing burden of advanced liver disease worldwide, coinciding with a global rise in obesity. The buildup of fat in the liver can lead to fibrosis, cirrhosis and liver cancer. Using noninvasive methods, the researchers assessed the presence of liver steatosis (fat accumulation) and fibrosis in 282 adults with HIV. More than one third (36%) had liver steatosis, 27% met the criteria for NAFLD and 10% had NASH. Nineteen people (7%) had at least moderate fibrosis. Having a larger waist circumference was a predictor of liver steatosis, and type 2 diabetes was a predictor of substantial fibrosis. The researchers suggested that noninvasive tests could help identify people with HIV who might benefit from improving their metabolic health to prevent progression to severe liver disease.