There must be 50 ways to lose your liver.
By Kelly McCann
The liver is both the largest internal organ in the body and the largest gland. In most adults, it is about the size of a football, and it is located on the right side of the upper abdomen. The liver plays a major role in metabolism, digestion, and blood clotting, and it performs about 500 other functions as well.
To give you some idea of how important that smooth, triangular, brown piece of meat (and I’m not referring to Mario Lopez) is to our health, consider this. Without a functioning liver, a person will usually die within 24 hours!
The liver can be damaged by alcohol abuse, overdose of certain medications, ingestion of, or exposure to, various chemicals, and viral infection. Currently, we know of six (and possibly seven) viruses that can lead to hepatitis, but three viruses cause the overwhelming majority of hepatitis cases in the U.S.
Hepatitis A Virus (HAV) is transmitted via a fecal-oral route, most often by consumption of contaminated food or water. But be aware, it can also be transmitted by unprotected oral-anal sex. Don’t give someone a rim job without placing plastic wrap, a dental dam or some sort of barrier between your mouth and your partner’s anus. The good news is that this virus causes an acute form of hepatitis, which lasts less than six months. It does not lead to a chronic infection and, thus, does not result in permanent liver damage.
Hepatitis B Virus (HBV) infection can cause both acute and chronic hepatitis. About 15 percent of people infected with this virus develop chronic hepatitis. As you might imagine, chronic hepatitis is the more serious course of the illness, as long-term infection can lead to cirrhosis or scarring of the liver, liver cancer, and even complete liver failure. Like HIV, the hepatitis B virus lives in the blood and sexual fluids of the infected person and is transmitted in the same ways that HIV is transmitted, through unprotected sex, sharing needles for drug use, tattooing, or body piercing, and breastfeeding. There is even risk of transmission from exposure to blood on razors, toothbrushes, or other personal hygiene devices.
Hepatitis C Virus (HCV) , originally called non-A, non-B hepatitis, was not identified until 1989. It is estimated that four million Americans are now infected with hep C, four times more than are living with HIV/AIDS! This virus is transmitted by blood-to-blood contact through blood transfusions received before 1992, needle-sharing, and even sexual activity if blood is present. This infection can remain asymptomatic for 10 to 20 years, but often leads to chronic hepatitis.
In the early stage of acute hepatitis, one may experience symptoms like fatigue, fever, muscle and joint aches, and nausea. Later symptoms include jaundice or yellowing of the skin and whites of the eyes, dark urine, and light-colored stool.
With chronic hepatitis (an infection lasting longer than six months), there are often no symptoms for many years. Once symptoms do appear, they often mimic the symptoms of acute hepatitis. Fatigue is by far the most common symptom, but persons with chronic hepatitis often report a feeling of pressure or pain below the right ribs. This is an indication of an enlarged liver.
The recommended treatment varies depending upon the virus one is infected with, the genotype of that virus, and whether the infection is acute or chronic. In short, the treatment for an acute hepatitis is no treatment. Just rest and let the infection run its course.
There are six FDA-approved treatment options for chronic hep B, including interferon and some anti-viral medications used to treat HIV, such as lamivudine. For chronic hep C, virus levels can often be reduced through a combination of interferon and the antiviral drug, ribavirin. However, it should be noted that certain genotypes of HCV do not respond well to treatment. In particular, genotype 1 is more resistant to therapy than other HCV genotypes.
For persons infected with HIV, it is important that they discuss hepatitis with their medical providers. There are vaccines to protect against infection with HAV and HBV, and it is strongly recommended that persons living with HIV/AIDS be vaccinated in order to prevent co-infection with HIV and hep. However, no vaccine exists for HCV at this time.
And if you have HIV and are already co-infected with HBV or HCV, there are important things to consider. Most studies suggest that viral hepatitis does not directly accelerate the progression of HIV disease, but HBV and HCV do appear to progress more rapidly in persons infected with HIV.
But do not despair! Positive treatment outcomes are possible for both diseases. However, the management of HIV/HBV or HCV co-infection can be complex, so seek out physicians who have experience with both diseases. And “save the liver”!
Kelly A. McCann is the chief executive officer of AIDS Foundation Houston. For testing information: AFH’s Prevention Services Department at 713/623-6796 or visit www.aidshelp.org.
In an old skit on Saturday Night Live, Dan Ackroyd portrayed chef Julia Child cutting up a chicken. Throughout the bit, “she” encouraged us to “Save the liver!” Julia was so right. The liver, largely unheralded, is vital to our good health and even our survival.