CATIE provides an information sheet on liver toxicity as part of its “Practical Guide to Managing HIV Drug Side-Effects.” This info sheet suggests ways of coping with liver impairment, which is frequent in people with HIV, and may result from a variety of factors, including medication side-effects, hepatitis co-infection, repeated use of antibiotics, alcohol or drug use, or a nutrient-poor, chemically-rich diet.
Here’s an excerpt on some supplementation strategies to counteract liver impairment:
In addition to removing, as much as possible, anything that might be stressing the liver, it is very important to add the therapeutic agents that can help the liver to detoxify, repair and protect itself. There are a number of potentially useful agents, listed below:
Nutrients to Maintain Glutathione
Glutathione (GSH) is the most important intracellular antioxidant and is crucially important for protecting the liver against toxicity when it goes about its task of breaking down drugs and other toxins. Taking the following nutrients may help to maintain or increase levels of glutathione:
–vitamin C (2–6 grams per day, in divided doses)
–N-acetyl-cysteine, or NAC (500 mg, 3 times per day; always take with food because taking it on an empty stomach can cause gastrointestinal tract irritation)
–L-glutamine (5 grams per day, increased up to 30–40 grams in those who also have diarrhea or wasting). Note that anyone with seriously compromised liver or kidney function should not take glutamine without a doctor’s approval since it is an amino acid that must be processed by those organs.
–alpha-lipoic acid, or thioctic acid (300-500 mg, twice daily; take on an empty stomach with fluids). Alpha-lipoic acid is a naturally occurring fatty acid that acts as a cellular coenzyme. It is very important to the liver cell metabolic pathways and can be rapidly depleted when the liver is under stress. It appears to help boost repair when there has been either virally induced or drug-induced liver damage. Note that alpha-lipoic acid disappears from the bloodstream very rapidly, so products made in an extended-release form will last longer and work better.
For anyone with liver dysfunction or disease, the above nutrients may be very important as part of a total treatment approach.
For people with fatty livers, another important nutrient is the amino acid carnitine. Researchers say that it may help prevent mitochondrial toxicity, thus helping the body to handle fat better. Early studies of its use for non-HAART-related elevated triglycerides in PHAs did, indeed, show successful lowering of the blood fat levels. Research in animals has shown its successful use in reversal of fatty livers. The usual dosage is two capsules (500 mg each) twice daily. The alternative is Carnitor, the basic form of carnitine, available by prescription only. It is usually prescribed in doses of 3,000 mg daily (three 330-mg capsules, 3 times daily). Too-high doses can cause diarrhea, so watch for this. Doses of plain carnitine need to be higher because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream, using equivalent doses.
Note that in addition to the individual supplements mentioned above, NYBC also stocks its combination of N-acetyl-cysteine and alpha-lipoic acid, ThiolNAC.