#APlenaVista

What do we want?

People living with HIV may be at increased risk of developing liver disease for a number of reasons. Despite its importance, people living with HIV have frequently been excluded from studies on steatotic liver disease, meaning there is still much to learn. This makes it even more important to prioritise liver health.

To improve the prevention, diagnosis and treatment of liver disease in people living with HIV, we call for the following:

• 1. Liver health should become a routine part of HIV care, both in clinical settings and community programmes.
• 2. HIV care teams should receive basic training on steatotic liver disease (SLD) and its main risk factors (metabolic disorders, co-infections, medications and social determinants).
• 3. Clinical guidelines and health policies should include measures for early detection, prevention and education on liver health.
• 4. Research studies and clinical trials on metabolic steatohepatitis (the more severe form) should include people living with HIV, with particular attention to women, who have been underrepresented and may be at greater risk of advanced liver disease.
• 5. Care teams should work in a collaborative and integrated way, bringing together HIV care, metabolic health and liver health within a single, holistic model of care.

What does the evidence show in Spain?

In Spain, as in many other countries, HIV care has achieved remarkable biomedical success. However, what lies outside the clinical focus often goes unnoticed. Recent studies convey a consistent, if understated, message: the shift from survival to long-term well-being has exposed the limitations of a healthcare system that continues to monitor what is easy to measure, rather than what truly defines health and well-being.

Although many people maintain an undetectable viral load thanks to effective viral suppression, people living with HIV (PLWH) continue to face the burden of multimorbidity, stigma and reduced quality of life, aspects that are rarely reflected in national monitoring systems or public policy frameworks.(1)

In Barcelona, participatory research involving people living with HIV has identified a clear priority: psychological distress and fatigue should be recognised as legitimate targets for intervention, rather than merely secondary symptoms, in order to improve health-related quality of life (HRQoL), a strong indicator of overall well-being.(2) Likewise, a network analysis involving people living with HIV from different regions of Spain confirmed this pattern: psychological distress acts as a central hub linking emotional, cognitive and physical domains, yet it is still not adequately assessed in routine clinical care,(3) just as other associated chronic conditions, including cardiovascular, kidney and liver diseases, are often overlooked. The development of a national composite index for long-term well-being—which shows that discrimination and poor quality of life are both causes and consequences of declining health—represents an important step towards addressing the lack of appropriate monitoring tools.(4)

At the same time, the growing body of evidence on steatotic liver disease among people living with HIV highlights another gap between current healthcare systems and the evolving needs of HIV care. Following the successful management of concomitant viral hepatitis, metabolic liver diseases—namely metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH)—remain largely invisible within the healthcare system, and consequently receive little attention in specialised HIV services.(5)

Recent qualitative research involving clinicians, researchers and community representatives reinforces this picture. While mental health and cardiovascular disease dominate the current discussion, MASLD is only just beginning to enter the clinical and policy agenda. This reflects a new frontier in HIV care, where metabolic health—and liver health in particular—is increasingly being recognised as a fundamental component of long-term well-being.(6)

From Evidence to Policy

Additional information (in English) from the Global Think-Tank on Steatotic Liver Disease, a collaborative initiative that brings together a wide range of stakeholders to advance the recognition, understanding, diagnosis and management of steatotic liver disease, with a particular focus on metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) as part of the broader metabolic health crisis.

Who Is Bringing Liver Health into Focus?

The #APlenaVista campaign was created to bring attention to where it matters most: liver health, with a particular focus on steatotic liver disease and its metabolic forms. Here, we highlight healthcare professionals, community voices, media outlets, radio programmes, institutions, academic partnerships and teams—including our own—that are helping to amplify these messages in clinics, communities and public spaces.

Our thanks go to everyone leading and supporting this effort, helping to improve the health and well-being of people living with HIV in Spain.

During ClínicObert, a citizen science festival organised by Hospital Clínic Barcelona, CAPSBE and IDIBAPS, the #APlenaVista campaign brought liver and metabolic health into the public space on Carrer de Casanova, between ISGlobal and Hospital Clínic.

As part of ISGlobal's Public Health Liver Group, Trenton White and Anthony Armenta led a community talk and workshop on preventing metabolic risk and steatotic liver disease in people living with HIV, while also broadening the conversation to highlight the importance of liver health for the general population. The session featured Javier Sotomayor, community worker at Gais Positius, together with infectious diseases specialist Dr Abiu Sempere, a member of the EACS Guidelines Panel on Comorbidities, who answered questions from clinical, community and preventive perspectives.