About one third of young people living with HIV may have non-alcoholic fatty liver disease (NAFLD). Over time, NAFLD can lead to inflammation, cirrhosis and liver cancer. It is often accompanied by obesity and metabolic syndrome. Management involves lifestyle changes, such as weight loss and exercise. Spanish researchers analyzed 38 children, adolescents and young adults with perinatal HIV, meaning they acquired the virus around the time of birth. They were all on antiretroviral therapy, and most had viral suppression. Eleven people with HIV (29%) were diagnosed with NAFLD using noninvasive imaging, compared with just three of 38 HIV-negative young people (8%). HIV--related parameters, such as viral load and CD4 cell count, generally did not differ significantly between those with and without NAFLD, and the condition was only partially explained by overweight and metabolic syndrome. The researchers suggested that routine liver ultrasound imaging should be considered for young people with perinatally acquired HIV.