How Can I Protect My Liver?

Posted by Pozziepinoy on 7:05 PM
(Source: 100 Questions and Answers About HIV and AIDS, 2nd edition, by Joel Gallant, MD, MPH)

The liver is a vitally important organ, though many people are unclear about what it actually does. Its functions are too numerous to list completely, but it's involved in metabolism, the chemical reactions that take place in the cells of the body, including the detoxification of many of the drugs we use to treat HIV. It makes proteins, stores fuel for the body, and secretes hormones and bile, which helps with digestion of food. Since it's so important, it's a good idea to keep it healthy.

Many antiretroviral drugs hurt the liver. Almost all of the PI's can cause liver damage, but usually only in people who have chronic hepatitis B or C. nevi rapine (Viramune) can be harmful to the liver, especially in women  with high CD4 counts. Stavudine (d4T, Zerit) and zidovudine (AZT, Retrovir, Combivir, Trizivir) can be harmful, too, especially if you also have lactic acidosis. Other medications commonly taken by HIV-positive people, such as cholesterol-lowering drugs, can also cause liver toxicity. Here are some tips for lowering your risk.

1. Get checked for hepatitis A, B and C. If you're not already immune to A and B, get vaccinated (preferably after you've taken your ART). If you have chronic hepatitis B or C, get evaluated by an expert to find out whether you need treatment. PCR tests are sometimes necessary to rule out hepatitis since it's possible to have hepatitis with negative serologies.

2. Get your transaminases (liver enzymes) checked frequently, especially when you've just started therapy. This is especially important with nevi rapine.

3. Avoid excessive alcohol use. Don't drink at all if you have chronic hepatitis B or C.

4. Use acetaminophen, the active ingredient in Tylenol and many other over-the-counter remedies, in moderation, and not at all if you have chronic hepatitis.

5. If you're taking medications for hepatitis B, don't stop them. Stopping treatment can cause dangerous hepatitis flares.

There are some who recommend herbal therapies, especially milk thistles, to "detoxify" or protect the liver, though the data are mixed. Some "natural products" may actually hurt the liver and worsen liver disease. There's no clear evidence that there's anything you can take to protect the liver.

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