Patients with cirrhotic livers may start to experience symptoms caused by the inability of blood to flow freely through the organ; as a result blood is diverted around the liver, which can cause a number of secondary symptoms.

Patients will also experience symptoms related to the deterioration in effective function of the liver. They include:

• Ascites, which leads to the swelling of the abdomen, caused by the accumulation of fluid
• Varices are distended blood vessels around the stomach and gullet which enlarge because the blood is trying to find a way around the scarred liver. These blood vessels can bleed into the stomach, which will need immediate treatment. The symptoms are vomiting up blood and / or passing black faeces.
• Circulatory changes. Because the liver doesn't break down certain blood chemicals as efficiently, blood vessels can become blocked, leading to the heart having to work harder and the dilation of blood vessels
• Encephalopathy. Patients may experience impaired mental function because the liver is not breaking down waste products in the blood as efficiently as it should or because blood is bypassing the liver. Laxatives are sometimes used to treat this
• Liver failure may develop as a result of long-term progression via cirrhosis or as a result of fulminant hepatitis which is characterised by the overwhelming of liver cells by pathogens and toxins, resulting in widespread necrosis (cell inflammation and death). It is treated by a transplant.
• Liver transplants currently have a high success rate. Survival rates for 5 years after the operation are around 80%.

Liver cancer

The exact mechanism through which these viruses cause cancer is the subject of considerable scientific speculation.  Hepatocellular carcinoma (HCC) is a particularly nasty form of cancer which can sometimes be treated by liver transplant. HIV co-infection is not a reason by itself to prevent a transplant and a number of successful liver transplants have already been performed in Britain on people co-infected with HIV. In the majority of people HCC comes after they have developed cirrhosis but a number of people have developed liver cancer without having cirrhosis first.

Complementary therapies

Silymarin or milk thistle is the most common alternative medication used by persons with hepatitis. It has been used to treat all forms of liver disease for over 2000 years. However, its effects have never been properly evaluated in controlled trials.

The widespread use of herbal products can pose serious health risks. Many alternative therapies are associated with significant liver toxicity. Agents to avoid include, chaparral leaf, valerian, skullcap, misteltoe, germander, Jin Bu Huan, and pyrrolizidine alkaloids.

For complementary approaches see Directory of Complementary Therapies in HIV & AIDS.