Liver Health

The liver [1]A large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. is one of the most important and largest organs in your body. It has been described as the body’s ‘chemical processing plant’. It plays a key role in food metabolism and digestion, in producing immune system proteins and importantly for people with HIV, in the breaking down of prescription and other drugs, and alcohol.

Older age (even without HIV) is associated with decreased liver function.

A healthy liver is important to process medicines effectively, so if your liver has been damaged by drinking too much alcohol, you are more likely to experience side effects from HIV medications (especially if you have hepatitis).
The blood fat [2]A fat. increases caused by some HIV medications can also be made worse by heavy drinking.

There are a number of reasons why people with HIV may be more likely to experience liver damage. These include:

• increased use of both prescription and over-thecounter medications, that can cause liver damage (especially paracetamol)
• increased incidence of hepatitis B and C
• increased levels of alcohol and other drug use.

Symptoms of liver damage include:

• pain in upper right abdomen or generalised abdominal pain
• fatigue
• nausea
• dark urine
• clay colored stool (faeces)
• jaundice (yellowing of the skin and white part of the eyes).

What can you do?

Look after your liver by:

• Getting vaccinated against hepatitis A and B
• Get appropriate treatment if you have hepatitis B or hepatitis C. There are now treatments available which are having increasing success rates, and when treatment is successful it substantially reduces the risk of longer term liver damage
• Eating a healthy diet with lots of fruit and vegetables
• Avoid taking more than 4 grams of paracetamol in any 24 hour period
• Avoiding high fat food (deep-fried foods, fatty meats, processed vegetable oils etc.)
• If you have hepatitis or high levels of blood fats [3]A type of fat in the blood. Elevated triglyceride levels may be a side effect of some anti-HIV drugs., you may have to cut down or stop drinking alcohol
• If you have liver disease, avoid high doses of vitamin A and high doses of iron. Some herbal therapies are liver toxic and some interact with HIV treatments in ways that are toxic to the liver.

Having HIV and hepatitis B or C can accelerate the progress of both infections and make both more difficult to treat. Hepatitis B is mainly spread through sex without a condom—particularly rough sex that draws blood, but can also be spread through sharing injecting equipment. Hepatitis C is mainly spread through sharing injecting equipment, but is rarely spread through sex.

• During sex, wash hands and toys and change condoms and gloves between partners
• If injecting, do not share any equipment, including spoons and tourniquets.

Monitor your liver’s health

You can have decreased liver function without any symptoms. Liver function tests (LFTs) are part of regular monitoring for people with HIV and results of LFTs in people with HIV are often outside of what is considered the ‘normal’ range. Such results do not necessarily mean you have, or are going to have, a huge problem with your liver. Your doctor will know when the LFT levels are something to be more concerned about.

Let your HIV or Hepatitis doctor know about all of the drugs you are on

As we get older it is often the case that we are on more and more drugs for various conditions, therefore the chances of having drug interactions increases.