The liver is the largest internal organ in your body. It is located at the upper right hand side of the abdomen. Having a healthy liver is important to everybody, but it is especially important to people with HIV as the liver plays an important part in processing medicines used to treat HIV. Viral infections which affect the liver, such as hepatitis A, hepatitis B and hepatitis C, can make you very ill and also mean that the liver is unable to process medicines properly.

What your liver does

Your liver has three major functions:

• It stores and filters blood, removing unwanted substances.
• It makes bile, which is released into your gut and helps digest fat.
• It processes nutrients from foods, releasing energy into your blood stream, and storing vitamins and minerals
• It manufactures proteins and certain vitamins

What can go wrong with your liver

Drinking a lot of alcohol over a long period of time can damage your liver, leaving it permanently scarred and unable to work properly.

Certain recreational drugs, such as heroin, cocaine, and ecstasy can also damage your liver.

Medicines used to treat illnesses and infections, including some HIV drugs, can also damage your liver, causing inflammation, known as hepatitis.

Viruses can also cause disease in the liver. This booklet gives detailed information on these viruses, mainly hepatitis B and hepatitis C, which can cause serious long-term or chronic illness. Information is also included on hepatitis A, which can also make you unwell, but only in the short term.

Fibrosis and cirrhosis

Hepatitis C, hepatitis B, excessive drinking and drug use can all damage the tissue in your liver. Two terms are used to describe this - fibrosis and cirrhosis.

If your liver has fibrosis this means that it has been hardened and scarred.  Fibrosis can be reversed if the cause is identified early enough.

Cirrhosis is severe scarring of the liver whereby it can no longer work properly. This can be very serious, causing jaundice, internal bleeding, and swelling of the abdomen. Damage caused by cirrhosis is often permanent.

Liver cancer

Chronic hepatitis B and hepatitis C significantly increase the chances of liver cancer developing.

If you have hepatitis C, liver cancer is most likely to happen when you have cirrhosis, particularly if you are a heavy drinker. Smoking may also speed up the rate of cirrhosis and increase the risk of developing liver cancer.

Liver cancer is difficult to treat and surgery is often the only option, involving the removal of part of the liver. Small tumours can be removed, but the chance of a new tumour developing within five years is high. Chemotherapy has no proven benefit against liver cancer.