Even though 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 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 ARV 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 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).
Non-allergic liver damage. Some drugs can cause liver damage without an allergic reaction or use at high doses. Two particular HIV drugs that can cause serious liver damage, though in relatively small numbers of people, are Aptivus (tipranavir) and Prezista (darunavir). People with hepatitis B virus (HBV) or hepatic C virus (HCV).
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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