The liver

plays a crucial role in how the body processes HIV medications


What do I need to know?


Age, lifestyle and other factors can all affect the health of the liver, whether you are HIV positive or not. But, liver health can decline more quickly in people living with HIV and there are some additional factors that put strain on the liver which people living with HIV should be aware of. These include:

  • Untreated HIV
  • Long-term use of some HIV medications
  • Viral hepatitis (mainly hepatitis B or C) – this can progress faster if you are also living with HIV

What else do I need to know?

Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly common in people with HIV. This has been linked to the long-term use of some, but not all, HIV medications.

Talk to your healthcare team about when to start HIV treatment or to review the medications you take. Also ask about your routine blood test results that show how your liver is working.

Hepatitis C, meditation and taking control

More about liver disease


The liver has a vital role in the way your body works, it helps:

  • Transform nutrients from food and drink into chemicals that give your body energy
  • Get rid of waste, cleansing blood of unwanted chemicals that might otherwise harm your body
  • Process medication, including HIV medications

The liver is put under greater strain the more medications or toxins (such as alcohol) it has to process. 

As we get older, the liver becomes less active and less efficient at digesting food and cleaning unwanted chemicals, which can lead to liver problems. 

What is liver disease?

Liver disease is a broad term used to describe many problems that affect the liver and make it less active. These include:

  • Hepatitis A infection – a vaccine is available to prevent you getting it but it is important to get the full schedule of two doses to ensure life-long protection
  • Hepatitis B infection – a vaccine is available to prevent you from getting it
  • Hepatitis C infection – there is no vaccine available but with modern treatments it's possible to cure the infection
  • Alcohol-related liver disease – this is caused by drinking too much alcohol. Treatment involves stopping drinking and psychological support may also be recommended
  • Non-alcoholic fatty liver disease (NAFLD) – a collective name for a range of conditions which are caused by fat being built up in the liver. NAFLD is common in people who are overweight or have diabetes and it is becoming increasingly frequent amongst people living with HIV. Treatment involves following a healthy diet and lifestyle  
  • Non-alcoholic steatohepatitis (NASH) – a more serious form of NAFLD
Can HIV cause liver disease?


Many people living with HIV have no problems with their liver. However, if you have HIV and particularly if you also have hepatitis B or C and/or drink heavily, your liver is likely to be under greater strain and more prone to problems.

Am I at risk?

Your healthcare team can assess your risk of developing liver disease; they may do the following:

  • Review your lifestyle choices to see if they are putting unwanted strain on your liver, such as:
    • Drinking heavily
    • Using injectable or recreational drugs, including steroids 
    • Having an unhealthy diet
  • Check how well your liver is working by taking routine blood tests
  • Test for viral hepatitis (mainly hepatitis B or C)
  • Review your medication (both HIV and any other medications), as some people with HIV may need to lower the amount of medications that they take, as it may cause damage to the liver

What if I am already living with liver disease?

One of the most effective ways to look after your liver is to lead a healthy lifestyle, even if you already have liver disease.

This includes:

  • Having a healthy diet
  • Not drinking too much alcohol
  • Not taking injectable or recreational drugs
  • Not using steroids

Talk to your healthcare team to review the amount of medications you take. This is because high levels of over the counter and prescription medicines (including HIV medication) can slow the liver’s ability to remove waste from the body. If this happens, you may begin to experience side-effects from your medication.

Your healthcare team can also advise you on how best to look after your liver, which is even more important if you are also living with hepatitis B or hepatitis C.

What should I ask?


  • What can I do to make sure I am taking the best care of my liver?
  • What symptoms are associated with liver disease?
  • Can any of my medications, including for HIV, affect my liver?
  • What is the best treatment to manage my HIV and any additional infections?
  • Should I be vaccinated for hepatitis A and B?
  • Is my alcohol intake at a safe level?
  • What are the risks of having both HIV and viral hepatitis?




  1. Use the alcohol self-assessment quiz to check if you are drinking safely
    And ask for help to cut down if you need to
  2. Avoid fatty foods and maintain a healthy weight
  3. Have protected sex with a condom
    As condomless sex can increase your chances of getting viral hepatitis
  1. Let your healthcare team know if you use steroids, street/recreational drugs
    And ask for help to cut down or stop
  2. Ask your healthcare team about your liver blood test results
  3. Get vaccinated for hepatitis A and B
  4. Get tested for hepatitis A, B and C
  1. Talk to your healthcare team
    About any supplements or other medications you take, which could put a strain on your liver
  2. Ask your healthcare team
    How all your medications, including for HIV, affects your liver
  3. Download apps that can help you monitor your health
    Such as recording your liver test results and offer support to stop drinking alcohol