The liver is a busy organ. It processes and distributes
food and medication throughout the body, and filters out foreign materials like drugs and
pollution. In a person who is HIV-positive, taking 25+ pills a day, and also trying to eat
well, the liver works overtime.
Liver damage can be caused by many things: infections (e.g.
hepatitis), alcohol, some street drugs (e.g. ecstasy), and many kinds of medications, from
acetaminophen (Tylenol) to protease inhibitors. It is a balancing act to care for the
liver and keep HIV under control with medications. We take the drugs for their benefit,
and hope that the liver can keep pace and repair itself. High liver function test (LFT)
numbers are the sign that the liver is affected, or that liver maintenance is falling
behind. SGOT (AST), SGPT (ALT), and bilirubin are the common LFTs. People on multiple HIV
medications may be stuck with high LFTs, but it is important to note that high LFTs don't
necessarily mean that liver damage is occurring. The meaning of high LFTs should be
discussed with a physician.
Signs of a liver flare-up may include a loss of appetite with
nausea/vomiting, an altered sense of taste, and in later stages, yellow skin (jaundice).
Your liver has no back-up; it's the only one you've got! Here are some pointers on caring
for it.
The first way to strengthen the liver is to reduce or eliminate the
use of alcohol and street drugs. A strong nutritional regimen is important: plenty of
calories, protein, fruits, and vegetables; easy on the fats; and a good vitamin/mineral
supplement regimen.
Liver disease may mean even more malabsorption of nutrients,
requiring supplementation especially in advanced disease. For instance, it is known that
nonalcoholic liver disease causes significant decreases in blood levels of the
immune-supportive minerals selenium and zinc, independent of nutritional status. [J Trace
Elern Med Biol 1997; 11(3): 158-611.] Avoid taking supplements with extra iron unless your
doctor has advised it.
Glutathione is a natural substance in the liver that detoxifies
drugs. Good nutrition keeps glutathione high by giving the liver the precursors of
glutathione, that is, the correct substances that the liver needs to make glutathione for
itself. Poor nutrition and alcohol lower glutathione.
Supplementation of the amino acid N-acetyl cysteine (NAC), used to
treat the liver damage caused by acetaminophen poisoning, is getting more attention for
general liver support. NAC increases levels of glutathione, and provides one of the
building blocks, cysteine, for the cytocbrome P450 enzyme system, a system in the liver,
which clears many HIV medications. While no double-blind studies have yet documented NAC's
efficacy in HIV disease, people with liver disease and HIV co-infection should watch for
emerging results. Some people use silymarin (or milk thistle) for the treatment of liver
disease, but again, there have not yet been any good studies to show whether it is
effective.
