NUCLEOSIDE anti-HIV drugs are known to cause

“Fatty liver”

Fatty Liver is a problem in which an abnormal amount of fat deposits in the liver. Fat enters the liver from the intestines after being digested. It may enter the liver from fatty tissue elsewhere in the body, or it may be made in the liver. Patients unable to break down fat, develop abnormal fat areas within liver cells and the entire liver.

A fatty liver is the most common cause of abnormal liver tests when no disease is present. Fatty liver can be caused by certain chemicals, diet problems, or by family heredity. Drugs and chemicals that can cause fatty liver include alcohol, tetracycline, methotrexate, valproic acid, cortisone and cortisone-like medications, carbon tetrachloride, and other solvents. Of these, alcohol is by far the most common cause. Liver inflammation may come from exposure to these toxins and is responsible for the symptoms of fever, tiredness, and yellow skin. People who do not drink and have a fatty liver are classified as having Non-Alcoholic Fatty Liver Disease. Most people with this also have what is known as the Metabolic Syndrome. If you have any 3 of the following, you may have the metabolic syndrome. The metabolic syndrome is associated with a high rate of heart disease.

· Fasting blood sugar above 110 mg/dL

· Fasting triglycerides above 150 mg/dL

· Low HDL (good cholesterol)—males < 40, females < 50

· Large waist size—males > 40 inches, females > 35 inches

· High blood pressure—systolic > 135, diastolic > 85

Nutritional causes of fat in the liver include starvation, poor nutrition, or obesity. Fat in the liver can also occur with rapid or extreme weight loss such as what might occur following an intestinal or gastric bypass operation for obesity. Severe cases can lead to cirrhosis of the liver (severe scarring of the liver). The hormonal causes of fatty liver include diabetes, high cholesterol, and fatty liver of pregnancy. Fatty liver during pregnancy occurs near the end of pregnancy and may cause early delivery of the baby or miscarriage.

Fat in the liver may not have any specific signs or symptoms. Sometimes patients will feel a dull pain in the right upper abdomen. Blood tests may show increased liver chemistries. A fatty liver can be seen on an ultrasound, CT, or magnetic resonance (MRI) of the liver. To know definitely if it is fatty liver, a liver biopsy will need to be done.

Fatty liver caused from alcohol use can worsen into a more severe disease including alcoholic hepatitis and cirrhosis.

Treatment of fatty liver depends on the cause. A fatty liver due to alcohol can be cured if alcohol use is stopped. Likewise, a fatty liver caused by HIV drugs, drug use or chemical exposure can be cured if the drug is stopped or the chemical exposure stopped.

To avoid the development of fatty liver:

· Do not drink alcohol in excess

· Eat a healthy, balanced diet.

· Avoid HIV Drugs

· Avoid concentrated sweets, saturated fats, and foods high in cholesterol.

· Whenever possible use healthy, unsaturated fats (olive oil, canola oil), instead of butter, lard, and corn oil.

· Seek medical advice