‘Hepatitis’ means inflammation of the liver. It may be caused by viruses, heavy alcohol use, fat accumulation in the liver, genetic diseases or other factors.

The liver is the largest internal organ, located on the upper right-hand side of the abdomen. It is responsible for many vital bodily functions, including:

• detoxifying blood, filtering out unwanted substances.
• making a substance called bile, which helps digest fat.
• processing nutrients from foods, releasing energy and storing vitamins and minerals.
• manufacturing proteins, hormones and certain vitamins.

Having a healthy liver is important for everyone, but especially for people living with HIV. The liver plays a vital role in processing drugs used to treat HIV and other conditions. People with severe liver damage may not be able to process their medicines properly.

In countries such as the UK, effective HIV treatment is widely available and people with HIV are living longer, healthier lives. However, hepatitis B and C are common among people living with HIV, and liver disease is now a major cause of illness, hospital admissions and death among people living with HIV. Hepatitis C now also has effective treatment, but it is not yet available for everyone who needs it.

You should have regular blood tests to monitor liver health as part of your routine HIV care. Increases in certain enzymes can indicate that the liver is not working properly or is being damaged. Find out more about these tests in NAM’s booklet CD4, viral load & other tests.

Drinking a lot of alcohol over many years can damage your liver, leaving it permanently scarred and unable to work properly. Certain recreational drugs, the commonly used pain medicine paracetamol (if taken in high doses or with alcohol) and some medications used to treat HIV and other illnesses can also cause liver inflammation and injury. The build-up of fat in the liver, known as fatty liver disease or steatosis, can also cause liver damage.

Viruses are another cause of liver inflammation and damage. This booklet gives detailed information about these viruses – chiefly hepatitis B and C – which can cause serious long-term or chronic illness. It also includes information about hepatitis A, which can make you unwell but usually only in the short term.

Hepatitis B or C, heavy drinking, and other causes can lead to long-term damage to your liver. Two terms used to describe this are fibrosis and cirrhosis.

Fibrosis means that healthy liver tissue is starting to be replaced by scar tissue, hardening the liver and interfering with its functions. Fibrosis progresses over time in people with hepatitis B or hepatitis C, and this tends to happen faster in people who also have HIV. Fibrosis can be partially reversed if the cause is identified and dealt with early enough.

Cirrhosis is severe scarring of the liver. Scar tissue replaces the cells that carry out the liver's normal functions and can block the flow of blood through the liver. If it progresses too far, the liver will no longer be able to work properly, possibly leading to problems such as internal bleeding and brain impairment. Liver damage is often permanent at this stage, but sometimes treatment can restore some lost function.

Liver fibrosis and cirrhosis are classified according to stages:

• F0 – no fibrosis
• F1 – mild fibrosis
• F2 – moderate fibrosis
• F3 – advanced fibrosis
• F4 – cirrhosis.

People with advanced fibrosis or cirrhosis are at higher risk of developing a type of liver cancer known as hepatocellular carcinoma. Liver cancer is hard to detect early and difficult to treat.

For more information, see Managing advanced liver disease.