Liver impairment in HIV disease

Liver Toxicity


Liver impairment in HIV disease is common and has many possible causes, only one of which are the medications you’re taking. Many infections can result in liver damage, including:

o co-infection with hepatitis viruses
o opportunistic infections such as MAC (Mycobacterium avium complex), TB (tuberculosis), CMV (cytomegalovirus) or cryptosporidiosis

Other factors that may damage your liver to the point that it is operating at less-than-optimal function, even before infection with HIV, include:

o repeated use of antibiotics
o excessive alcohol or recreational drug use
o a nutrient-poor, chemically loaded diet

On top of that are the many HIV drugs which can also cause liver toxicity. The combination of all of these explains why a certain level of liver toxicity and dysfunction is a frequent occurrence in PHAs.

The liver uses enzymes to help it get rid of the waste produced in your body both by normal body processes and by the breakdown of drugs, alcohol and other toxins. When the liver is overly stressed by this waste or damaged by various infections, liver enzyme tests done on blood samples may show significantly elevated values. These liver enzyme tests include the following:

o AST, also called SGOT (aspartate amino transferase)
o ALT, also called SGPT (alanine amino transferase)
o GGPT
o AP (alkaline phosphatase)
o LDH (lactic dehydrogenase)

All PHAs on HAART should have their liver enzymes monitored on a regular basis since liver damage is rarely something that is felt until it is quite advanced. It is especially important that people who already have some liver damage — because of hepatitis, for example — get regular blood tests for liver enzymes.

Bilirubin (a waste product) is also used as an indicator of liver disease. Note that some of these tests can be elevated by problems other than liver disease, so they must be interpreted carefully. However, even without elevations in these tests, there can be a level of less obvious liver dysfunction that should be addressed. Unfortunately, many people remain unaware of liver disease until it reaches a point that causes:

o pain
o swelling (hepatomegaly, or enlarged liver)
o fever
o jaundice (when the liver dysfunction results in an inability to break down bilirubin, which then causes yellowing of the skin and/or eyes)