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HIV- Related Liver Disease- Symptoms, Diagnosis, and Treatment

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HIV weakens the body’s immune system and can cause liver problems. It may lead to inflammation, scarring, or even liver failure if not treated properly.

Written byDr. Devanga Manjushree Selvaraj

Medically reviewed byDr. Ghulam Fareed

Published At January 3, 2023
Reviewed AtNovember 20, 2025

What Is HIV-Related Liver Disease?

Liver disease is still a major health problem for people living with HIV, even with better treatments today. Have you ever wondered how HIV affects the liver? Let us explore the connection together!

Many things can cause liver problems in HIV, such as infections like hepatitis, too much fat in the liver, alcohol use, or side effects from medicines.

HIV weakens the body’s immune system, which can lead to different liver problems such as hepatitis (liver infection), fatty liver, liver scarring (fibrosis or cirrhosis), and sometimes even liver cancer. When talking about liver problems in an HIV infection, it is important to remember that early care and proper treatment can prevent serious complications.

What Are the Common HIV-Related Liver Diseases?

  • Hepatitis A: Caused by eating or drinking dirty food or water, or through unprotected sex. In people with HIV, it can make the liver more inflamed and make it harder to process HIV medicines.

  • Hepatitis B: Spreads from mother to baby during birth, through infected blood, or unprotected sex. It can cause long-term liver damage, especially in people with HIV. A vaccine is available for prevention.

  • Hepatitis C: Spread through infected blood, sharing needles, or unprotected sex. Causes liver problems like cirrhosis (scarring) and liver failure.

  • Liver cancers: People with HIV have a higher risk of liver cancer (hepatocellular carcinoma) and other cancers like Kaposi’s sarcoma and lymphoma, which can affect the liver.

  • Fatty liver: HIV increases the risk of fatty liver, most commonly known as NAFLD (non-alcoholic fatty liver disease).

  • NASH (Non-alcoholic steatohepatitis): Increased liver fibrosis due to chronic HIV infection.

  • Hepatotoxicity: Some HIV medicines can be hard on the liver and cause damage since the liver helps process most drugs. Regular monitoring helps catch this early.

What Are the Signs and Symptoms of Liver Disease in HIV Individuals?

Have you noticed any symptoms like yellowish skin or fatigue? These might be signs of liver disease. Let’s discuss what to look out for!

  • Scleral icterus: The white part of the eyes turns yellow because of a substance called bilirubin (which builds up when the liver is not working well).

  • Hepatomegaly: This means the liver becomes bigger than normal. It can happen in people with liver disease or certain cancers linked to HIV.

  • Fatigue: Feeling very tired.

  • Loss of appetite: Not feeling hungry.

  • Fever: Having a high body temperature.

  • Ascites: Swelling of the belly due to fluid buildup.

  • Yellowish skin: The skin may also turn yellow, like in jaundice.

  • Nail changes: White fingernails (leukonychia), swollen fingertips (clubbing), yellow skin, and small red marks on the skin called spider nevi.

What Causes Liver Disease in HIV Individuals?

HIV can directly and indirectly harm the liver. The HIV virus will weaken the immune system, making it tough for the body to fight infections and toxins. This often leads to HIV causing liver issues, such as inflammation, scarring, and fat buildup in the liver.

Common causes:

  • Drinking too much alcohol for a long time.

  • Using drugs or taking too much medicine (like high doses of Paracetamol).

  • Some HIV medicines (like Nevirapine) may also irritate or damage the liver.

  • Fat buildup in the liver (called fatty liver disease) can cause liver damage.

  • Hepatitis A spreads through dirty food, water, or oral-anal contact. It usually lasts a short time but may stay longer in people with HIV.

  • Hepatitis B spreads through unprotected sex or infected blood. There is a vaccine to prevent it.

  • Hepatitis C spreads through infected blood, sharing needles, or certain sexual activities.

  • Some older HIV drugs can be toxic to the liver.

  • Having other infections or a weakened immune system from HIV makes the liver more likely to get sick.

How to Diagnose HIV-Related Liver Disease?

Diagnosis of this condition is based on various laboratory tests, imaging tests, and viral tests:

  • Test for liver enzymes - Aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT).

  • Bilirubin test - A test that measures the level of bilirubin in the blood.

  • Alkaline phosphatase - This group of enzymes is normally found in the liver. When the liver ducts are blocked or do not function properly, AP (alkaline phosphatase) is not released into the bloodstream.

  • International normalized ratio (INR) - This test checks blood clotting and monitors Warfarin therapy. It is also a reliable test for synthetic liver function in liver disease.

  • Albumin - It is a protein released by the liver; in chronic liver diseases like cirrhosis, its level decreases.

  • Imaging tests: Ultrasound of the abdomen, CT (computed tomography) scan, MRI (magnetic resonance imaging), and fibroscan.

What Is the Treatment for HIV-Related Liver Disease?

  • Strict follow-up in the HIV medication regimen and controlled HIV can help control complications.

  • Hepatitis A is usually manageable by drinking plenty of water, resting, and avoiding alcohol. Vaccination can prevent this condition more effectively.

  • Hepatitis B is treated with the same drugs used in HIV; this is also manageable by following hygiene protocols.

  • To manage hepatitis C and protect the liver, it is important to maintain good liver health. People with HIV should always take vaccines for hepatitis A and B to prevent further infections.

  • They should avoid unprotected sex to reduce the risk of spreading or getting new infections.

  • Alcohol consumption should be limited or avoided to prevent liver damage.

  • Maintaining good hygiene and avoiding poor sanitation helps prevent other infections. Always use sterile injections and never share needles.

Conclusion:

Untreated HIV can increase the risk of liver problems. A person should start their antiretroviral therapy (ART) immediately after HIV diagnosis to prevent HIV-related liver and other diseases.

HIV-related liver diseases cannot be diagnosed initially, but regular check-ups on liver function and HIV disease progression can help in treatment. If you notice any liver-related symptoms, consult a specialist for proper diagnosis and timely treatment.

Key Takeaways

  • HIV weakens the immune system and leads to liver problems.

  • Regular checkups and liver function tests are needed in HIV patients for early detection and management of liver damage.

  • Avoiding alcohol, taking medications (as prescribed), and following up regularly with a doctor are key to protecting liver health.

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Frequently Asked Questions

Yes, in a few cases, the liver can be affected due to HIV in people. When the viral load is undetectable, HIV can infect liver cells and result in persistent inflammation, which can harm organs throughout the body. Liver damage, fibrosis, and cirrhosis occur if it is left untreated. The liver can also be damaged if people drink alcohol and have viral hepatitis, NAFLD (Non-alcoholic fatty liver disease), HIV, and usage of few medicines, which will be a part of this mechanism.
On average, 13 to 18 percent of liver-related diseases will cause mortality in HIV-infected people. And this is the main cause for non- AIDS-related deaths in people. HBV and HCV are also included in the list of HIV-infected people who are more prone to liver disease, and it also plays an important role in causing mortality and morbidity. A conference is designed to address the increasingly prevalent clinical issues and challenges associated with HIV and liver disease in 2023 for both HIV and liver disease. Hepatology and infectious diseases are included in this conference, which helps bring clinicians from various disciplines and internationally renowned experts to the conference. In addition, the current and clinically relevant information about improving patient outcomes is also seen and discussed at the conference.
Yes, there are chances for HIV- infected patients with the controlled disease (CD4 counts are restored by suppressing the HIV RNA) to develop liver disease from simple and common causes like alcohol, hepatitis, NAFLD, and aging, in addition to direct injury to the liver by the HIV. Also, a large amount of HAART-related toxicity will result in liver problems.
In the past, HIV could kill people only in rare cases. It can happen only when the patients are left untreated, which will help HIV to gradually progress to an acquired immunodeficiency syndrome (AIDS) in most people. But nowadays, the death rates from AIDS have declined globally, and this condition also increases the susceptibility to opportunistic infections, ultimately resulting in a patient's death.
Yes, liver enzymes are affected by HIV. because HIV-infected patients taking antiretroviral medications will show an elevation in their liver enzymes called AST and ALT, which will indicate a chance of liver damage in them. Even though there are many reasons for these elevations, like infections with the hepatitis virus, antiretroviral medication alone will cause these types of elevations.
Yes, primarily viral agents like HBV, HCV, and HIV are the primary diseases that affect the liver cells through immune-mediated mechanisms.
Usually, the host's normal transcription machinery can transcribe HIV DNA into multiple copies of new HIV RNA. In a few cases, some of the RNA becomes the genome of a new virus, while the cell uses the other copies of the RNA into new HIV proteins. HIV can not copy itself, so they go into these cells for this process. because it can not reproduce on its own. So in the first step, the virus attaches itself to the T-helper cells and joins them together. Then it will take control of the cell's DNA and make copies of itself in the cell, and finally, more HIV is released into the body.
As HIV is a viral infection, it can affect the individual body through a mechanism it targets and gradually weakens the body's immune system by damaging cells called CD4 T cells. This damage will gradually make the body unable to fight off other infections. And if an immune system becomes impaired enough, the typically mild infections can be life-threatening.
HIV and hepatitis can cause infections because bloodborne viruses are transmitted primarily through sexual contact and injection-drug usage. In addition, as modes of transmission share these viruses, there will be a high proportion of adults at risk for HIV infection, and also, they are at risk for HBV infection.
Yes, HIV can affect the life of an individual. Because if people have a serious illness or condition like HIV, they will be associated with stress, which directly affects their mental health. Anxiety, mood, and cognitive disorders are commonly seen in people with HIV. For example, people with HIV will face a most common mental health condition called depression.
People with HIV are more prone to cause liver diseases. HIV will cause persistent inflammation in the individual and causes infections in the liver cells, even though they have an undetectable viral load in the individual which in turn causes harm to the organs throughout the body.
It is very important to note that after an individual is diagnosed with HIV, then they should undergo all the available blood tests to know whether they are having any infections additional to this HIV. as the risk of acquiring these infections is more in HIV patients, it is mandatory to check at regular intervals. And also, by checking the liver's health, one can easily detect the presence of these viruses in them. People living with human immunodeficiency virus or acquired immunodeficiency syndrome will probably have liver function test (LFT) abnormalities that are widely present, around 20 to 93 percent.
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Dr. Ghulam Fareed from iCliniq
Dr. Ghulam Fareed

Medical Gastroenterology

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