by Shari Margolese
December 2004
Your liver is one of the most important organs in your body. It is also the largest – about the size of a football. It is protected from injury behind the lower right section of your ribs.
The liver acts as your body’s chemical processing plant. Its functions include:
- Converting nutrients into chemicals and proteins that your body needs to stay healthy
- Storing nutrients from the foods you eat
- Breaking down drugs and alcohol
- Removing waste from your blood
- Producing enzymes and bile that help you digest food
- Producing proteins needed by the immune system to help your body resist infection
For HIV+ people, the liver is of major importance because it processes many of the drugs used to treat HIV. Unfortunately, the HIV medications can cause hepatotoxicity (liver damage), which can prevent the liver from functioning properly.
In addition, HIV+ people may have liver damage or stress on their livers caused by:
- Other prescription medications, over-the-counter drugs such as acetaminophen (Tylenol), repeated use of antibiotics, or exposure to chemicals
- AIDS related opportunistic infections (OIs) such as MAC (mycobacterium avium complex), TB (tuberculosis), CMV (cytomegalovirus), or cryptosporidiosis
- Hepatitis (an inflammation of the liver) usually caused by infection with a virus such as hepatitis A, B, or C
- Alcohol or drug abuse
Some liver problems only occur during pregnancy or affect women more often then men. These include:
- Gallstones
- Biliary cirrhosis (bile duct damage)
- Autoimmune liver diseases
- Non-alcoholic fatty liver disease
- Hepatic adenomas (liver tumors)
In addition, women tend to develop alcohol-related liver disease, particularly cirrhosis (scarring of the liver) and hepatitis, after a shorter period than men.
Oral contraceptives (birth control pills) can cause an increase in hepatic adenomas (liver tumors) and should not be used in women who have a significant history of these benign (non-cancerous) tumors.
The nucleoside reverse transcriptase inhibitor (NRTI) class of HIV drugs can have negative side effects that may lead to liver problems. One such side effect is mitochondrial toxicity.
Mitochondria are inside of cells and produce energy by breaking down sugars and fat. At the same time, lactic acid is made as a waste product. Normally, the body breaks down lactic acid and gets rid of it.
In mitochondrial toxicity, the mitochondria are damaged and lactic acid is not broken down. This can cause levels of lactic acid to become elevated. If these levels become too high, a rare, but serious condition called lactic acidosis can occur.
Lactic acidosis can result in liver problems, including a buildup of fat in and around the liver and liver inflammation. This condition is more common in HIV+ women than men, especially pregnant or obese women.
Special blood tests called liver function tests (LFTs) are one of the best ways to find out if you have liver damage. LFTs measure the levels of certain liver enzymes in your bloodstream. High enzyme levels can indicate liver damage caused by medications, alcohol, hepatitis, or street drugs. LFTs are usually part of routine HIV blood work. The most common LFTs are:
- ALT or SGPT (alanine aminotransferase)
- AST or SGOT (aspartate aminotransferase)
- Bilirubin
- Alkaline phosphotase
Symptoms of liver damage or liver disease include:
- Pain
- Enlarged liver
- Fatigue
- Nausea
- Dark urine
- Clay-colored stool
- Jaundice (yellowing of the skin, eyes, and mucous membranes)
If you have these symptoms you should call your doctor.
The liver has a special ability to repair itself under most circumstances. Unfortunately, permanent damage can also occur.
If your HIV drugs are causing damage to your liver, it may be possible to switch to other drugs. This may not be an option for everyone. It is important to balance the need for HIV drugs with their potential to cause liver damage.
There are many things that you can do to protect your liver from damage, help it to heal, and support its function.
- Heavy drinking can cause cirrhosis
- Many HIV drugs and other medications should not be combined with alcohol
- Avoid alcohol completely if you are co-infected with hepatitis
- Using some street drugs (including Ecstasy) may affect your liver
- Make sure that you are vaccinated against hepatitis A and hepatitis B
- Many HIV+ people are co-infected with the hepatitis C virus (HCV). If you are, make sure your doctor is monitoring both infections and providing appropriate care and treatment. If you are not, avoid contact with infected blood or needles to reduce your risk of acquiring HCV. (There is currently no HCV vaccine.)
- Achieve and maintain a healthy body weight through diet and exercise
- Eat plenty of fruits and vegetables, especially dark green leafy vegetables and orange and red colored fruits and vegetables
- Drink large amounts of fluids, especially water
- Avoid high-fat dairy products, processed vegetable oils (hydrogenated fats), deep-fried foods, and fatty meats
- Take a multivitamin with antioxidants
- Do not take high doses of vitamin A or carotenoids (beta-carotene) if you have liver disease
- Avoid high levels of iron
- Herbal therapies, such as milk thistle (silymarin), have been widely used to treat the liver. Some herbs are toxic to the liver and some interact with HIV drugs. It is important to tell your doctor if you are using any herb or supplement
When your liver is damaged it cannot perform all of its important functions properly. Since there may not be any obvious symptoms of liver damage, it is important to monitor your liver health with regular check ups and lab tests. Work with your doctor to determine what HIV drugs are best for you and your liver. In addition, good nutrition and a healthy lifestyle will help to support this hardworking organ.
| 1 | |
Centers for Disease Control and Prevention. (2004). Viral hepatitis. Retrieved December 2004 from: |
| 2 | |
National Institutes of Health. (1998). Liver and biliary diseases among women and minorities. Retrieved December 2004 from: |
