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Hepatitis B (HBV) and fatty liver disease (FLD) are common etiologies of liver disease in HIV. Correlates of FLD and its relationship with alanine aminotransferase (ALT) overtime were examined in HIV-HBV coinfection. From 04/28/14-11/07/18, 114 HIV-HBV adults underwent a liver biopsy and were followed for a median of 3 years (ancillary study of Hepatitis B Research Network). Steatohepatitis was based on presence of steatosis, ballooning and perisinusoidal fibrosis. FLD was defined as ≥5% steatosis and/or steatohepatitis. Median age was