#APlenaVista
What are we talking about?
Steatotic liver disease (SLD) —formerly known as "fatty liver disease"— is a progressive and largely silent condition. It is estimated to affect more than one-third of adults worldwide and is now the fastest-growing cause of liver-related death. Within this global context, people living with HIV (PLWH) represent a high-risk clinical group: SLD develops earlier and progresses more rapidly due to chronic immune activation, visceral fat accumulation and the long-term metabolic effects of antiretroviral therapy.
The #APlenaVista campaign stems from a simple but important observation: in Spain, steatotic liver disease remains largely overlooked in HIV care, despite being one of the comorbidities with the greatest impact on the health of people living with HIV.
#APlenaVista draws inspiration from an idea that the Spanish artist Diego Velázquez expressed centuries ago in Las Meninas: what we see depends on where we choose to look, and what matters gains significance when we deliberately pay attention to it, even if it has never occupied the centre of the painting. This cultural metaphor helps explain why we are bringing the liver into focus in HIV care: not because it has been absent, but because it has yet to occupy the same place in routine diagnosis and health monitoring, particularly regarding metabolic steatotic liver disease (the more severe form), which science now recognises as one of the major long-term health challenges for people living with HIV.
#APlenaVista promotes the integration of liver health into HIV care in Spain by bringing together resources, interviews, articles and scientific publications so that communities, healthcare professionals and researchers can share a common message and move towards more preventive, equitable and integrated care, giving people living with HIV greater opportunities to achieve a good quality of life.
Will you help us shift the focus?
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)
2.White TM, Gresle AS, Roqueta J, Pine C, Lazarus JV. Co-Creation of Patient-Centered Metrics for Long-Term Well-Being Involving People with HIV and HIV Care Providers. AIDS Patient Care STDs. 2024 Oct;38(10):487-492.
3.White TM, et al. Network analysis to prioritise issues for intervention to improve the health-related quality of life of people with HIV in Spain. HIV Med, 2024; (11):1240-1252.
4.Fuster-RuizdeApodaca MJ, White TM, Prats-Silvestre C, Holgado-Tello FP, Lazarus JV. A metric to measure long-term well-being of people living with HIV in Spain. BMC Med. 2025;23(1):460.
5.Pericàs JM, Arora AK, Riebensahm C, Jiménez-Masip A, Ramírez Mena A, White TM, et al. An HIV and steatotic liver disease 2030 agenda. The Lancet HIV, 2024; S2352-3018(24)00097-3.
6.White TM, et al. Provider, researcher, and community perspectives on comorbidities affecting the health-related quality of life of people living with HIV in Spain. BMC Public Health. Under review.
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.
From ISGlobal, postdoctoral researcher Trenton White and Anthony Armenta, Communications Lead for the Public Health Liver Group, both members of the same team, took part in the PositHIVa March (October 2025).
Under the slogan Visibility = Dignity, the march brought together advocates and participants from across Spain, including community organisations, academic institutions and the Ministry of Health. It provided an important opportunity to share a clear message: liver health is about much more than preventing viral hepatitis. The simple T-shirts we designed helped spark conversations and broaden the focus towards long-term liver and metabolic health.
Postdoctoral researcher Trenton White appeared on Boulevard 2 (EITB, Basque Country) to discuss long-term well-being and integrated HIV care in Spain. He highlighted that truly integrated HIV care must address the psychological, psychosocial and physical needs of people living with HIV.
The Public Health Liver Group collaborated with UNITE on a blog article raising awareness of steatotic liver disease among people living with HIV, ahead of the second meeting of UNITE's Informal Working Group on HIV at the European Parliament. UNITE is a global network of current and former parliamentarians committed to strengthening health systems worldwide through sustainable, evidence-informed policies aligned with the United Nations Sustainable Development Goals (SDGs).
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.
