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Caring for Your Liver if You Have HIV/AIDS

July 2012

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Table of Contents

Liver Basics

Your liver is one of the most important organs in your body. It is also the largest -- about the size of a football. It is protected from injury behind the lower right section of your ribs.

The liver acts as your body's chemical processing plant. Its functions include:

  • Changing food into chemicals and nutrients that your body needs to stay healthy
  • Storing nutrients from the foods you eat
  • Breaking down drugs and alcohol
  • Removing waste from your blood
  • Producing enzymes and bile that help you digest food
  • Making proteins needed by the immune system to help your body resist infection

For people living with HIV (HIV+), the liver is particularly important because it processes many of the drugs used to treat HIV. Unfortunately, HIV drugs can cause liver damage, which can prevent the liver from working properly.

Symptoms of Liver Damage

Symptoms of liver damage or liver disease include:

  • Pain
  • Enlarged liver
  • Fatigue (extreme tiredness)
  • Nausea
  • Dark urine
  • Clay-colored stool
  • Jaundice (yellowing of the skin, eyes, and mucous membranes)

If you have these symptoms it is important that you contact your health care provider. However, there are frequently no obvious signs of liver damage until it reaches a late stage. That is why it is important to have blood tests that can detect liver problems before symptoms arise.

Tests for Liver Damage

Simple blood tests called liver function tests (LFTs) or liver enzyme tests are one of the best ways to find out if you have liver damage. LFTs should be part of routine HIV blood work.

The most common LFTs are:

  • ALT or SGPT (alanine aminotransferase): liver enzyme
  • AST or SGOT (aspartate aminotransferase): liver enzyme
  • ALP (alkaline phosphotase): liver enzyme
  • Bilirubin: a blood pigment and by-product of the breakdown of red blood cells

High enzyme levels can indicate liver damage caused by medications, alcohol, hepatitis (an inflammation of the liver), or street drugs.

High levels of bilirubin may indicate liver problems. Taking the HIV drug Reyataz (atazanavir) can increase bilirubin levels. However, in HIV+ people taking Reyataz, an elevation in bilirubin is a harmless side effect of how the medication is processed by the body.

The Liver and HIV

While it is possible for any HIV drug in any of the five HIV drug classes to cause liver damage, some drugs are more likely to cause damage than others.

Certain drugs in the nucleoside reverse transcriptase inhibitor class (NRTI) are more likely to have negative side effects that may lead to liver problems. One such side effect is mitochondrial toxicity. Mitochondria are inside of cells and produce energy by breaking down sugars and fat. At the same time, lactic acid is made as a waste product. Normally, the body breaks down lactic acid and gets rid of it.


In mitochondrial toxicity, the mitochondria are damaged and lactic acid is not broken down. This can cause levels of lactic acid to rise. If the levels of lactic acid become too high, a rare, but serious condition called lactic acidosis can occur.

Lactic acidosis can result in liver problems, including a buildup of fat in and around the liver and liver inflammation. This condition is more common in HIV-positive women than men, especially pregnant or obese women.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs), especially Viramune (nevirapine), can cause liver problems. Research has shown that women with more than 250 CD4 cells are 12 times more likely to develop life-threatening liver problems when they use Viramune. Viramune should not be used as first-time treatment in women with CD4 counts over 250. In addition, women with over 250 CD4 cells should not switch to Viramune unless there are no other options. In men, liver problems are more likely to occur if the CD4 count is above 400 at the time of starting HIV treatment with Viramune for the first time.

The greatest risk of liver problems occurs during the first six weeks of treatment with Viramune. It is important that your health care provider order liver function tests before you start taking Viramune and test your blood frequently during the first three to four months of treatment.

Protease inhibitors (PIs), especially full-dose Norvir (ritonavir) and Aptivus (tipranavir) given with Norvir, are also associated with liver damage. Unlike Viramune, PIs may cause liver damage at any time. Patients infected with both HIV and hepatitis C may be at higher risk for developing liver damage while taking PIs.

In addition, HIV-positive people may have liver damage or stress on their livers caused by:

  • Other prescription medications, over-the-counter drugs such as Tylenol (acetaminophen), repeated use of antibiotics, or exposure to chemicals
  • AIDS related opportunistic infections (OIs) such as MAC (mycobacterium avium complex), TB (tuberculosis), CMV (cytomegalovirus), or cryptosporidiosis
  • Hepatitis usually caused by infection with the hepatitis A, B, or C virus
  • Alcohol or drug abuse
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
See Also
More on Medication-Related Liver Problems

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