Non-alcoholic fatty liver disease (NAFLD) affects 25% of adults in the general population and is a disease spectrum ranging from steatosis to non-alcoholic steatohepatitis (NASH) to end-stage liver disease. NAFLD is an independent risk factor for cardiovascular disease, diabetes mellitus and all-cause mortality, and NASH cirrhosis is a frequent indication for liver transplantation. In persons with HIV (PWH), chronic liver disease is the second leading cause of non-HIV-related mortality. Between 20-63% of PWH have NASH, and 14-63% have NASH with fibrosis. However, little is known about the optimal diagnostic strategies, risk factors for and treatment of NAFLD in PWH. Here we review current data on and identify knowledge gaps in the epidemiology, pathophysiology, diagnosis and management of NAFLD in PWH and highlight priorities for research.