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Fatigue and AnemiaFatigue and Anemia
          
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no energy -- is it my liver?
Jan 22, 2003

Hey Dr. Bob, Here's the scoop. I've been positoid for as long as you -- (10+ years). Recently I've felt totally wiped out. My HIV doc said it's my liver. How can that be? I had hepatits A many years ago. I've been on several HAART combos and my numbers could be better but aren't terrible either. I do party harty now and then but usually keep it limited to alcohol (maybe 4 or 5 cosmopolitans per night on the weekends). My doc is worthless when it comes to explaining things. Can you help me understand what's going on? My ex-lover was recently diagnosed with hepatits C --- we still have sex, now and then ---- usually safe. OK, that's my story. I'll be sending a check to your Foundation -- can yopu send me a copy of your Concerted Effort 2002: Concert for Worls AIDS Concert video? I'd love to hear you and Dr. Steve (he's a total hottie, by the way) play the piano. I heard the whole concerted effort event was amazing. A friend told me you raised like 750,000! You go Dr. Bob. One other thing ... I don't want you to go the worried well forum --- WE NEED YOU HERE. Those neurotic worried wells have no idea what it's like to live with this illness. They should stop bothering you and start thanking their lucky stars. Hugs to you, Peter Positive

Response from Dr. Frascino

Hello Mr. Positive,

Can the liver be an energy zapper? Absolutely!

A good friend of mine, who is a hepatologist (liver specialist) once told me - quite innocently - "The quality of life is in the liver." He, of course, was referring to the remarkable organ residing between our stomach and lungs. I, on the other hand, felt the comment was more universal. "The quality of life is in the 'liver'" (the person who is living the life). I think both interpretations are valid. So with that as a background, let's discuss your problem.

The liver is an organ that does all kinds of stuff for us. Generally speaking, it metabolizes (processes) what we ingest. It can turn food into energy, clean out toxins, and balance our whole body chemistry.

There are a variety of things that can go wrong with our livers, such as:

1. Infections: such as hepatitis A, B, or C. 2. Toxic overload: from too much booze or strong medications 3. Cancer

Once the liver gets inflamed or damaged, its ability to process and filter stuff decreases and we can get quite sick from the backlog of sludge in our system. Liver failure can be lethal.

Symptoms of a failing or inflamed liver can include: fatigue, jaundice (yellow skin), dark urine, nausea, vomiting, pain, and abdominal swelling. In the case of hepatitis C, it may take up to 20 years before symptoms appear!

You've had hepatitis A before, so that's no longer a worry for you. Hepatitis B and C can co-infect we HIVers to the tune of 10 percent (hep B) and 40 percent (hep C). Other causes of liver problems include street drugs, alcohol, some HIV meds, anabolic steroids, oral contraceptives, and cancer.

Diagnosing liver problems involves blood tests (liver function tests), as well as tests to check for hepatitis A, B and C. Sometimes even a liver biopsy is needed.

Treatment? Well it's getting better. For hepatitis B, a combination of 3TC, Viread, adefovir, and famvir may be helpful. Hep C is more challenging to treat. Best option at the moment is a combination of pegylated interferon plus ribavirin. Interferon can cause lots of side effects, including severe flu-like symptoms and depression. Ribavirin is no picnic either, because it frequently causes anemia. Luckily, Procrit, a medication that can stimulate the production of new red blood cells, can often be used effectively and safely to treat ribavirin-induced anemia problems. Even with aggressive treatment, sometimes the liver doesn't recover; in which case, a liver transplant would be a last resort.

What should we HIVers do to protect the vitality of our livers? For starters, get vaccinated for hepatitis A and B (sorry no vaccine for hepatitis C yet). The liver is also quite remarkable at making comebacks (like Bette Midler or Judy Garland). The best chance for a liver comeback, or "regeneration" (also like Judy Garland) would involve kicking bad habits such as booze and drugs (especially street drugs - heroine, etc.). You would also need to eat well, exercise, and drink lots of water.

So back to your situation. First, find out if your liver is really in trouble or not. Make that mute HIV doc talk about the results of your liver function tests and hepatitis screens. If your liver is inflamed or damaged, find out how bad it is. You may even need to see a specialist (gastroenterologist or hepatologist). If you are susceptible to hepatitis A or B, and haven't been vaccinated yet, roll up those sleeves and get ready for a "little prick."

As for your 4 or 5 cosmopolitans per night, perhaps you've been watching too much "Sex in the City" episodes on HBO. Even Carrie and Samantha would have a hangover after that much booze! Even if your liver is fine, you might want to cut back a bit. If your liver is in trouble, you may have to cut back completely! Now, exactly what does "party-harty" mean? Street drugs are notorious for gunking up our livers and may play havoc with our HIV meds too! Beware!

Finally, sex with an ex? That's fine and dandy, but the "usually safe" part is not. I don't know the ex's HIV status, but even if he's positive, the possibility of re-infection with a different strain of HIV is a reality. Also, hepatitis C can be transmitted sexually, --although much more efficiently by sharing needles.

So Pete, that's the story. You're the "liver" of your life and your liver helps you live it well.

Thanks for your contribution to The Foundation. We raised over $90,000 at our recent Concerted Effort 2002: A Concert for World AIDS Day benefit. Steve (yes, I think he's a hottie too!) and I (and The Foundation) have raised over $750,000 since we started giving concerts in 1996. Yes, you can purchase a video ($25 each) of the event from our foundation's office:

The Robert James Frascino AIDS Foundation 779 Altos Oaks Drive, Suite 200 Los Altos, CA 94024

Include a request for a video with your donation and we'll send one out!

Finally don't worry Poz Petey, I'm not planning on leaving the Anemia/Fatigue Forum! I'd miss the wonderful cyberfriends I've developed here. I plan to stay as long as I am needed and/or as long as I am able. Since I'm planning on dying of old age, and there seems to be no shortage of folks writing in questions about fatigue/anemia, I'll hopefully be here for a very long time. The Safe Sex/Prevention position would be in addition to this forum and hopefully would allow us to keep this forum dedicated strictly to HIV-poz folks. However, nothing has been decided yet, so for now I'll just accept your hugs and wish you the very best.

Dr. Bob


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