Question
Can you talk about fatty liver and also changing treatment?
24 June 2015. Related: All topics, Changing treatment, Opportunistic infections, Side effects.
I have been diagnosed HIV positive since January 2013 and soon after, from March 2013 until today I was put on medication (Atripla) as part of a newly diagnosed cohort. My infection was estimated to have taken place in summer 2012.
CD4 count was 380 when I started the medication and rose gradually to current number 753 whilst having undetectable viral load.
Recently I was told by my doctor that I might have fatty liver as part of routine blood tests and this was confirmed by ultrasound examination as well as with cholesterol above 6. How serious is this and what should expect next? I have sourced information on internet indicating that fatty liver can give rise to cirrosis and this is what I m very worried about. Can I live with this condition and manage it with diet or should I do anything else?
Doctor mentioned statins but the question I got is if I need to switch to other medication. Besides Atripla was never an easy drug for me as I started initially with development rash in the first month, which was resoled then, but other daily debilitating symptoms such as daily diarrhoea bouts and/or gas and red eyes at work continue until today.
I hear that other people live normal lives once stable on medication but obviously gas and very loose stools do not contribute to my normal life. In addition I have to deal with fatty live which scares me a lot now.
Answer
Hi
Thanks for your email which includes several different important questions.
Firstly, the NHS website is a good source of information about fatty liver.
http://www.nhs.uk/conditions/fatty-liver-disease/Pages/Introduction.aspx
The NHS information is a good overview of how fatty liver is diagnosed and managed. This is mainly related to how mild or advanced it is and the likely underlying cause. For example if this is related to being overweight or alcohol use then management will involve looking at diet and exercise or reducing drinking.
Management is likely to be similar to that for HIV negative people.
Statins are also commonly used by HIV positive people, especially if cholesterol is high. This should be first prescribed by your HIV doctor because of the potential for some statins to interact with some HIV meds.
The second part of your email talks about side effects relating to Atripla, These are likely to be related to the efavirenz in Atripla, although tenofovir has also been linked to bloating and gas.
It is great that you already started treatment and that your CD4 response has been good, but your quality of life is just as important. There are many other HIV drugs that are just as effective as Atripla at treating HIV, but which might have fewer or even no side effects.
Please talk to your doctor about alternative options and let us know how you get on. It is easy to talk through these options afterwards if you get back in touch.
Also, it is interesting that the new UK treatment guidelines, have decided to no longer recommend Atripla as first-line therapy. These were posted online for comment earlier this week.
http://www.bhiva.org/treatment-guidelines-consultation.aspx
This is also make it easier for you to switch to alternative combinations but please let me know if you have any difficulty or have other questions.
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