The Gut, Liver And Metabolome in Human Immunodeficiency Virus and Non Alcoholic Fatty Liver Disease

Inclusion Criteria: * One of the following: 1. One or more of the components of metabolic syndrome, defined as: 1. Diagnosis of diabetes: on medication for diabetes for at least 6 months, HbA1c \>6.5%, or fasting glucose \>99 mg/dL 2. Elevated fasting triglycerides: \>149 mg/dL or on medication for dyslipidemia 3. Reduced HDL-C: \<40 mg/dL in males, \<50 mg/dL in females or on medication for dyslipidemia 4. Elevated blood pressure: \>129 mm Hg systolic and/or \>84 mm Hg diastolic or on medication for hypertension 5. Prior diagnosis of hepatic steatosis or NAFLD: hepatic steatosis noted on interpretation of clinical imaging, CT scan liver density of less than 58 HU, Fibroscan CAP score \>238 dB/m, MRI-PDFF ≥5%, liver biopsy showing ≥5% triglyceride content 2. Persistently abnormal transaminases: elevated liver enzymes defined by transaminases ≥1.5 upper limit of normal (\[ULN\] = 35 IU/mL) and/or gammaglutamyltransferase level ≥2 ULN (ULN = 60 IU/L) on 2 blood samples within at least a 3-month interval 3. BMI ≥ 30 kg/m2 * Documented HIV infection * On antiretroviral therapy for at least 18 months * HIV-1 RNA \<50 copies/ml for the prior 12 months * CD4 count \>350 cells/microliter for the prior 12 months * Ability to be contacted by phone (home or cell) * Access to a private (i.e. accessible only to participant and immediate family or roommates) refrigerator for 6 months * Able and willing to comply with all study protocols and procedures Exclusion Criteria: * Not fluent in English * Known allergy to the study product or its formulation * Pregnant or planning to become pregnant within the next six months * History of chronic diarrhea in the past three months * Breastfeeding * History of celiac disease * Prior diagnosis of non-NAFLD liver disease including, but not limited to, Wilson Disease, hemochromatosis, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and alpha 1 antitrypsin deficiency * On medications associated with secondary NAFLD including systemic corticosteroids, tamoxifen, methotrexate, nifedipine, history of cancer chemotherapy, * Positive hepatitis C quant or on treatment for hepatitis C within the last 12 months * History of cirrhosis or liver transplant * AUDIT-C score ≥3 women and ≥4 in men * History of inflammatory bowel disease * History of all other GI surgery within the past 12 months * Use of antibiotics in the past 30 days * Metal shrapnel, MRI incompatible hardware or claustrophobia that would preclude MRI imaging * Inability to participate in the study in the opinion of the participant's HIV treatment provider * Use of prebiotic(s) including fiber supplements and/or probiotic(s) within the past 90 days * Participant has history of hemicolectomy, colectomy, small bowel resection, bariatric surgery, gastric bypass surgery, or short bowel syndrome