Symptoms

Hepatitis is the common term for liver inflammation from any cause. It may not cause any symptoms, or it may cause pain in the upper right quadrant of the abdomen, swelling near the bottom right of the rib cage or tenderness under the right side of the rib cage. Occasionally jaundice (yellowing of the whites of the eyes and skin) will occur depending on the severity of the liver problem. Infrequent symptoms of liver inflammation include bloating and wind from eating fatty and fried foods. Tiredness, fatigue or lethargy are common symptoms. Changes may occur with blood fat levels (cholesterol and triglycerides).

Causes

Hepatitis A, B and C are viral infections that are common causes of hepatitis. Most HIV antiviral drugs affect the liver to some degree (see drug side effects table). Nucleosides can cause the development of a syndrome of fatty liver (hepatic steatosis), and this may be more common in people who have pre-existing liver damage (from hepatitis C for example).

Protease inhibitors can also cause liver inflammation and liver enzyme changes. When used at full dose, rather than in a ‘baby dose' to boost the absorption of other protease inhibitors, ritonavir causes liver inflammation more frequently than other protease inhibitors. Of the non-nucleosides, nevirapine and delavirdine are more likely to cause liver enzyme elevations (and even liver failure) than efavirenz. Liver inflammation can also occur because of poor diet (particularly saturated fat diets), recreational drug side effects, alcohol or other infections.

Complementary & Supportive Therapy

Dietary supplements: Dandelion tea (Taraxicum officianalis ) is a useful tonic for all liver diseases and jaundice. Chicory (Cichorium intybus ) resembles dandelion in its medicinal action, and may also be drunk as a coffee substitute like dandelion.

Yellow Dock (Rumex crispus ) herb is a useful herb for cleansing the liver, and is particularly useful for bilious complaints (e.g. jaundice). Globe artichoke is a liver tonic, often used as a component in liver supplements.

Vitamin E is a key liver nutrient and is stored in the liver. Vitamin E lowers the level of the liver enzyme ALT (used as an indicator of liver function in liver function tests). Vitamin E may reduce scarring when liver tissue heals. Vitamin E, and a number of other herbal compounds, have been cited as beneficial treatments for hepatitis C.

Spirulina may be a useful supplement to support liver health. The essential amino acid, methionine, is sometimes prescribed by naturopaths to improve liver function and prevent liver damage by removing toxins and heavy metal contaminants from the liver. Methionine may also assist in the prevention of accumulation of fat in the liver. Vitamin C, alpha lipoic acid and lecithin may also assist liver health through their antioxidant capacities and nutrients.

Milk thistle (Silybum marianum ) is a common herbal liver tonic often used to combat viral hepatitis and the liver toxic effects of some HIV antiviral drugs by reducing liver inflammation. Milk thistle is useful for rebuilding the liver when it has been compromised or weakened by promoting the growth of new liver cells. It prevents toxins from penetrating through healthy liver cells by binding itself to the cell membranes.

Diet: Dietary needs are dependent on the degree of liver damage and the presence or absence of other complications. Individual requirements will vary greatly so it is important that advice be sought from a dietician. General nutrition recommendations for hepatitis include maintaining a healthy balanced diet, with adequate water intake (eight glasses per day), limiting overly fatty foods, and limiting or avoiding alcohol consumption, particularly binge drinking sessions or heavy drinking.

Medical & Drug Treatment

Appropriate medications and therapy will depend on the extent and nature of the type of liver inflammation (hepatitis). Liver Function Tests (LFTs) are used to assess the level of damage to your liver. Mild to moderate hepatitis can be reasonably well controlled through supportive dietary and natural approaches. Your doctor may recommend modification of your HIV antiviral drugs. Many of these drugs are broken down in the liver, which can lead to liver inflammation. Treatments include interferon and ribavirin for hepatitis C and 3TC/tenofovir/adefovir for hepatitis B.

Special Precautions & Considerations

• Some herbs may have negative interactions with HIV antiviral drugs, and either reduce or increase drug levels. Always check herbs for known or possible interactions with your doctor or health care provider.
• Milk thistle (Silybum marianum ) may potentially interact with protease inhibitors and non-nucleosides and should be avoided when taking these HIV antiviral drugs, despite potential benefits to liver health. Milk thistle may cause mild nausea, diarrhoea, loose stools or an allergic reaction.
• Several herbs and plant compounds including some Chinese herbs have been reported to have various degrees of adverse effects on the liver. The herb Kava (Piper methysticum ) has been shown to cause liver injury, resulting in a death in a few cases. There are some concerns about the purity of some herbal medicines. Impurities may occasionally cause serious liver injury or complications in people with (or without) chronic viral hepatitis. The tendency for people to alter herbal formulas and use larger doses than prescribed may be why remedies that have been used traditionally for hundreds of years have recently been identified as causing liver problems. Consultation with your doctor is recommended to assist your decisions in relation to herbal treatments.
• Dandelion (Taraxicum officianalis ) creates excessive urination, which can result in the loss of important minerals and tissue salts. It may also be laxative, worsening diarrhoea if present. Use dandelion tea in moderation.
• Avoid excessive fat-soluble vitamin intake (e.g. vitamins A & D) as toxicity is possible with compromised liver function. Toxicity is less likely from beta carotene but it may cause problems in some people, so check with your doctor before taking any additional supplements.