Question

What is the situation for HIV positive people on medication who have previous alcohol-based liver damage?

25 August 2010. Related: All topics, Living with HIV long-term, Other tests, Side effects, Starting treatment.

Please tell me about the situation for HIV postive people who have prior alcohol based liver disease. How are they able to deal with the HIV medication? Say for example, somebody with mild liver damage, is diagnosed as HIV positive – how long will it take on medication before their liver becomes severely damaged?

Answer

Answer: Charlotte Walker

Thank you for your question.

If someone has previous liver damage then they will be very closely monitored by their HIV doctor and by a liver specialist. The HIV treatments they will be given will be chosen specifically with their liver function in mind. The dosage of the HIV treatments will also be tested and monitored to ensure that the liver is well looked after and not overworked. This way it is possible for someone with mild liver damage to never have a severely damaged liver.

Most HIV treatments are filtered by the liver and so could potentially affect liver function. If someone is aware that they already have liver problems then there are some medications they should try to avoid. These include nevirapine, ritonavir, tipranavir and possibly also efavirenz as studies have shown similarities between nevirapine and efavirenz in terms of liver toxicity.

If someone with previous liver toxicity is already taking some of the above-mentioned medications then they should ask their HIV doctor for a Therapeutic Drug Monitoring (TDM) test. This measures the level of HIV medication in the blood and it could indicate that a lower dose needs to be given.

There are certain lifestyle changes that could help with maintaining the liver such as

• Getting hepatitis A and hepatitis B vaccines. Having another viral infection in your liver can worsen hepatitis C.
• Drinking less, or stoping drinking alcohol—the less you drink, the better for your liver.
• Maintaining normal weight. Being overweight increases your risk for fatty liver.
• Drinking plenty of water, to help your liver filter out waste and toxins.
• Eating fewer fatty, salty and high sugar foods.
• Trying to eat more fresh fruit and vegetables, complex carbohydrates (whole grains, breads, rice, pasta, cereals, vegetables, fruits, beans, nuts and seeds), low-fat foods, high-fibre foods and an adequate amount of protein.

For more information please follow this link to a specific page on the liver in the i-Base guide to ‘Avoiding and Managing Side Effects’