Your liver has important functions in your body. It is located in the upper right side of your abdomen and is the primary organ for fat (lipid) metabolism. The liver is vulnerable to injury, cancer, and other problems including infection (hepatitis) and fatty infiltration (nonalcoholic fatty liver disease). In addition, alcohol itself or in combination with these problems can lead to more liver damage. As an older person living with HIV/AIDS you need to be aware of these problems. If these processes go too far, the liver can lose function and enlarge due to scaring and fibrosis. Enlargement can result in fluid accumulation in the abdomen, bleeding in your swallowing tube (esophagus), and such other problems associated with the diagnosis of cirrhosis of the liver and possible death. Fortunately, treatments are available to prevent cirrhosis and liver transplants are being used more frequently when no other options are available.
Hepatitis A Virus (HAV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) are more common in older adults with HIV. This is because many people with HIV have higher behavioral risk factors for hepatitis., such as drug injection and anal sex. Also, the complications of HBV and HCV can be worse in those with HIV in comparison to those without these infections. However, there are approaches to diagnosis and treatment that can limit the negative effects of hepatitis infection that you should discuss with your healthcare team.
DISCUSS TESTING, DIAGNOSIS, AND TREATMENT WITH YOUR DOCTOR
Older adults living with HIV/AIDS should have been tested for the presence of HAV, HBV, and HCV at the time of HIV diagnosis. If positive for these infections, your healthcare provider should have provided appropriate treatment. However, it is possible that you were not prescribed treatment or completed it, especially in the case of HCV infection. Only recently has HCV been recognized for its seriousness and the importance of treatment. Also, even in the presence of previous negative test for HCV, the test should be done at regular intervals because of the possibility of reinfection. In addition, your healthcare provider should check your liver enzymes, as they can be indicative of early liver damage.
If you are HAV negative, your healthcare provider may recommend you take a vaccine against it. If you are infected with HAV, there are currently no specific treatments for the infection, and you should take precautions to prevent exposing others to the virus through fecal exposure or poor hygiene. If you are HBV negative, an effective vaccine is also available. If you test positive for HBV, then treatment is needed. There are a number of antiretroviral medications that are also effective against HBV. Your healthcare provider may prescribe two of them together. These medications are common and well tolerated.
If you have been infected with HCV, you should be treated with medication to cure you of the infection. HCV can affect not only the liver, but also the kidneys and the heart. A course of HCV treatment can be completed in a matter of weeks. These medications, however, are expensive – and you may need assistance from your healthcare team to ensure your insurance will cover the cost.
Also, you can be re-infected with HCV after treatment. You should address risky behaviors, such as injection drug use, that can result in HCV reinfection.
NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Even if you drink little or no alcohol and are not infected with viral hepatitis, you may be at risk for nonalcoholic fatty liver disease (NAFLD). In some form, NAFLD affects an estimated 25% of the general population and slightly more in adults with HIV (31%). As suggested by the name, the condition is associated with increases in fat cells (steatosis) in the liver. However, a subgroup of people with NAFLD can develop high amounts of fat in the liver with more serious complications. This condition is called NASH (nonalcoholic steatohepatitis), and can follow a course similar to viral hepatitis resulting in scarring due to inflammation and the onset of cirrhosis. It is unknown why some people collect large amounts of fat in the liver. However, the risk appears higher in people who are overweight or obese, as well as in those with high blood sugar levels and elevated levels of certain blood fats, such as triglycerides. NAFLD may usually have no symptoms, but sometimes pain over the upper right part of the abdomen occurs, where the liver is located. A healthcare provider will diagnose the condition with an ultrasound, a non-invasive technique. However, sometimes a simple needle biopsy of the liver may be needed to confirm a diagnosis. Treatment is limited to addressing weight reduction, control of sugar and lipids, although certain medications can be used.
DISCUSS TESTING, DIAGNOSIS AND TREATMENT WITH YOUR DOCTOR
Because NAFLD has minimal symptoms, your healthcare team will need to be aware of possible indicators of this disease. They include elevated levels of triglycerides and sugar in your blood tests, as well as being overweight. It would be appropriate for you to discuss the importance of the ultrasound test and having it done. A NAFLD diagnosis could motivate you to take steps to address the condition. Modest efforts on your part could reduce levels of fat in your liver, which, in turn, may decrease the size of your liver and bring the condition under control.
WHAT CAN YOU DO TO MINIMIZE LIVER DISEASE?
In terms of preventing viral hepatitis, you should consider taking the vaccines for HAV and HBV, if indicated. Also, if you are infected with HBV, you will need to take the antiretroviral medication prescribed to control the infection. You might request that your liver function tests be done periodically. Finally, after treatment for HCV, you should take steps to prevent getting reinfected.
For NAFLD risk factors, you will need to choose a healthy diet with fruits and vegetables and lower fats. To lose and maintain a normal weight, you should consider reducing calorie intake and exercising regularly. In some cases, your healthcare provider may prescribe medications to lower blood fats or recommend a vitamin E supplement in modest doses. These lifestyle changes can have a major effect on your long-term health.
Liver diseases can be very dangerous to the body, but they can be prevented or treated. An important factor in liver health is reduction of alcohol intake. A study of HIV patients conducted by the Veterans Affairs found that no more than one drink a day was optimal for longevity. If liver damage has already occurred, you may need to abstain entirely from alcohol. These lifestyle changes are possible and will make your life better. You and your doctor can work together to accomplish this goal.