People living with HIV who have fat accumulation around the heart have poorer metabolic health and are more likely to develop liver fibrosis than people without HIV, according to a recent study. As they age, people with HIV are more prone to comorbidities, including cardiovascular and liver disease. Italian researchers evaluated the link between increased epicardial fat thickness (the amount of fat surrounding the heart) and liver stiffness, a measure of liver fibrosis, in 91 people on effective antiretroviral therapy. They found that 30% of those with epicardial fat thickness above the median had a liver stiffness measurement suggesting clinically relevant liver fibrosis, compared with 11% of those with less fat around their heart. Worse insulin resistance predicted increased epicardial fat and liver stiffness, while greater liver stiffness also correlated with current and nadir (lowest-ever) CD4 T-cell counts. The researchers concluded that people with greater epicardial fat thickness have a worse metabolic profile and are more likely to have clinically relevant fibrosis even with normal liver function tests.