Even though anti-HIV drugs are intended to do your health good, the liver
recognizes these medications as toxic compounds. After all, they are not
naturally produced by the body and do contain some chemicals that could
potentially cause damage to your body. Working with the kidneys and other
organs, the liver processes these drugs to render them safer. In the process,
the liver can become "overworked," which can lead to liver damage.
There are actually two ways that anti-HIV meds can lead to liver damage:
Direct damage to liver cells:
Liver cells, called hepatocytes, play a vital role in the functioning
of the liver. If these cells begin working too hard to remove chemicals
from the blood, or if they are harmed by other infections (e.g.,
hepatitis C virus), abnormal chemical
reactions can occur that can damage these cells. There are actually
three ways in which this can happen:
Taking a very high dose of a drug. If you were to swallow
a high dose of an anti-HIV drug or another medication (i.e., taking
many pills when you are supposed to take one or two), this can
cause immediate and sometimes severe damage to liver cells. Almost
any drug, if an overdose is taken, can cause this type of liver
damage.
Taking standard doses of medication for a long period of
time. If you take medications on a regular basis for a long
period of time, there is also a risk of damage to these liver
cells. This usually occurs after several months or years of taking
certain medications. Protease inhibitors have the ability to cause
damage to liver cells if they are used for long periods of time.
An allergic reaction. When we hear the term "allergic
reaction," we often think of itchy skin or runny eyes. However,
allergic reactions can also take place in the liver. If you are
allergic to a particular drug, your immune system can cause your
liver to become inflamed as a result of interactions between key
liver proteins and the drug. If the drug is not stopped, the inflammation
can worsen and can cause serious damage to the liver. Two anti-HIV
drugs known to cause such allergic reactions (sometimes referred
to as "hypersensitivity") in HIV-positive people are
Ziagen® (abacavir) and Viramune®
(nevirapine). Allergic reactions such as these usually occur within
a few weeks or months after the drug is started and either may
or may not be accompanied by other allergy-related symptoms (e.g.,
fever or a rash).
Lactic Acidosis:
Nucleoside reverse transcriptase
inhibitors (NRTIs) are not processed by they liver; they are removed
from the bloodstream and from the body by the kidneys. Thus, many
experts once speculated that these drugs would not likely cause damage
to the liver. But, we now know that these drugs can damage "cellular
mitochondria," the "powerhouses" inside cells that
convert nutrients into energy. This can cause levels of lactate, a
cellular waste product, to become elevated. If these levels become
too high, a condition called lactic acidosis can occur, which can
result in liver problems, including a buildup of fat in and around
the liver and liver inflammation.
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