by Liz Highleyman
Hepatitis is a general name for an inflammation, or swelling, of the liver. Hepatitis is caused by a number of different things, including:
- Viruses, such as hepatitis A, B, and C, which cause specific types of hepatitis
- Heavy alcohol use
- Damage from drugs, including prescription drugs, or toxic chemicals (known as “hepatotoxicity”)
- Attack by the body’s immune system (a form of hepatitis called autoimmune hepatitis)
First, a little background information about your liver. The liver is the largest organ in your body. It is located on the upper right side of your abdomen, just beneath your ribcage. The liver is responsible for some 500 functions vital to your body’s health. One thing it does is process the foods you eat, playing an important role in metabolism (your body’s way of creating energy). It converts food into energy that your body can use, and also stores sugar, fats, and certain vitamins for later use. Liver cells produce a substance called bile, which helps you digest fats and absorb nutrients. The liver also makes many important proteins, including certain hormones and chemicals that help your blood to clot.
In addition, the liver is responsible for processing many drugs (including prescription, over-the-counter, and recreational or street drugs, as well as alcohol), and detoxifying (filtering, processing, and getting rid of) toxic chemicals in the body. If you are exposed to a large amount of toxic chemicals—for example, if you ate a poisonous mushroom—your liver can become overwhelmed and damaged.
Whatever its cause, all forms of hepatitis have some common symptoms:
- Fatigue (unusual tiredness)
- Loss of appetite
- Nausea and vomiting
- Pain in the abdomen, in the area around the liver
- Flu-like feeling
- Jaundice (yellowing of the skin and whites of the eyes, and sometimes mucous membranes, like those inside your mouth and throat)
Many people with hepatitis have only minor symptoms that resemble the flu, while some people have no symptoms at all. . But in some people, liver damage gets worse over time, leading to more serious consequences, especially if hepatitis goes untreated. These include, in order of increasing severity:
- Fibrosis (when normal liver tissue becomes stringy and fibrous)
- Cirrhosis (when normal liver cells are replaced by scar tissue)
- Liver cancer
- End-stage liver disease (when the liver can no longer perform its vital functions)
- The need to have a liver transplant
Because the liver carries out so many important activities, many different body systems can be affected when it stops working as it should. Some conditions are a direct result of the liver not being able to do its job. Others are caused when scar tissue develops in the liver as a result of damage, interfering with the flow of blood (through the liver). Some of the things that can occur with liver damage are:
- Itching due to the buildup of toxic chemicals
- "Brain fog,” or forgetfulness, confusion, and other mental changes, or encephalopathy (brain disease)
- Easy bruising or bleeding that takes a long time to stop
- Weakened blood vessels in the esophagus (swallowing tube) and stomach, which may burst and cause internal bleeding
- Swelling of the abdomen or ankles and feet
- Coma or loss of consciousness (specifically called hepatic coma)
Elevated blood levels of certain liver enzymes can be an important early sign of liver problems (although some people with liver disease never have elevated enzymes). Liver enzymes called ALT and AST help break down the food you eat in order to build new proteins needed by your body. If you are already receiving medical care for HIV, you may already know about these tests. Generally testing the levels of these enzymes is part of routine HIV care.
Enzyme levels can go up in your blood as a direct result of damage to your liver; when liver cells are damaged, these particular enzymes, ALT and AST, may actually leak out of the liver and migrate to your blood, where they start accumulating in higher amounts than normal. Some HIV drugs, such as Norvir (ritonavir) or Viramune (nevirapine), can put stress on your liver. Another sign of liver problems can be increased levels of bilirubin, a pigment released when old blood cells are broken down. Some HIV drugs such as Crixivan (indinavir) or Reyataz (atazanavir) can cause high bilirubin levels, which may lead to jaundice. However, the increase in bilirubin with these drugs does not appear to cause problems for the liver. In any case, your doctor should monitor your liver enzyme and bilirubin levels regularly while you are taking HIV drugs.
It can be hard to tell one type of hepatitis from another based on symptoms and lab tests alone. Antibody tests are used to show if you are infected with one of the hepatitis viruses, A, B, or C. Doctors also use liver biopsies (in which a small sample of liver tissue is withdrawn using a needle and examined under a microscope) to assess the type of liver damage and how severe it is.
If you have hepatitis, here may be things you can do to help slow down or stop liver damage from getting any worse. For example, studies show that alcohol destroys liver cells. Alcohol alone can cause liver cirrhosis, or speed up liver damage due to viral hepatitis (A, B, or C). If you are taking an HIV drug that is known to cause elevated liver enzymes, ask your doctor if another medication might be a better choice for you. The liver can repair its own tissue, and it just may be able to heal itself once the offending chemicals (e.g., alcohol or Norvir) are gone.
Hepatitis A goes away on its own, but hepatitis B and C may become chronic (that is, they last longer than six months, and sometimes for years). There are medications to treat hepatitis B and C, but (as with HIV treatments) the drugs may not completely get rid of the virus.
Whether you have an existing liver disease like hepatitis B or C, or are taking HIV drugs that stress your liver, here are some steps you can take to help keep your liver as healthy as possible:
- Eat a healthy, well-balanced diet
- Avoid or limit your use of alcohol and recreational drugs
- Try to avoid toxic substances and fumes such as paint thinners and pesticides
- Take no more than the recommended dose of any medication
- Do not mix medications unless directed by your doctor
- Tell your doctor about all prescription and over-the-counter medications, recreational drugs, herbal remedies, and vitamins and supplements you are using, even if you only use them occasionally
Aidsmeds.com. (2002). Risks to your liver (hepatotoxicity): Retrieved July 2003 from http://www.aidsmeds.com/lessons/Hepatotoxicity1.htm
Cohen, M., et. al. (2000). The hepatitis C help book: A groundbreaking treatment program combining western and eastern medicine for maximum wellness and healing. New York, New York: St. Martin’s.
The National Women’s Health Information Center. (2002). Hepatitis. Retrieved July 2003 from:
Project Inform. (2002). Towards a healthy liver: Retrieved July 2003 from http://www.projinf.org/fs/liver.html