References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Liver disease is one of the leading causes of non-AIDS-related illness and death in people with HIV. Co-infection with hepatitis B or C, alcohol use, fatty liver disease and some antiretroviral drugs can all affect the liver. With proactive monitoring and treatment, most liver problems can be managed well.
Here’s what to know about protecting your liver when you’re living with HIV.
Order a discreet home HIV test
Why Liver Health Matters with HIV
- HIV itself causes chronic inflammation that affects the liver
- Hepatitis B and C co-infection accelerates liver damage
- Some ART drugs are processed by the liver
- Alcohol use compounds liver stress
- Non-alcoholic fatty liver disease is increasingly common
Common Liver Conditions in HIV
| Condition | Cause | Management |
|---|---|---|
| Hepatitis B co-infection | HBV virus | ART containing tenofovir treats both |
| Hepatitis C co-infection | HCV virus | Direct-acting antivirals cure over 95% |
| Alcoholic liver disease | Excess alcohol | Reduce or stop alcohol |
| Non-alcoholic fatty liver | Metabolic syndrome, weight gain | Diet, exercise, weight management |
| Drug-induced liver injury | Some ART or other drugs | Switch medication |
Hepatitis C: The Curable One
Hepatitis C can now be cured in over 95% of people using direct-acting antiviral (DAA) treatment, usually a 12-week course of tablets. DAAs are safe with HIV medication and are available free on the NHS. If you have hepatitis C co-infection, treatment should be a priority.
Monitoring Your Liver
- Liver blood tests (ALT, AST) at every routine HIV clinic visit
- Hepatitis B and C screening at diagnosis and periodically
- FibroScan or liver elastography to assess scarring
- Liver ultrasound every 6 months if you have cirrhosis (cancer screening)
Protecting Your Liver
- Limit alcohol — or stop entirely if you have hepatitis co-infection
- Get vaccinated — hepatitis A and B vaccines if not already immune
- Treat hepatitis C — it’s curable
- Stay on ART — uncontrolled HIV worsens liver disease
- Maintain a healthy weight — fatty liver is increasingly common
- Avoid unnecessary paracetamol overuse — stick to recommended doses
- Tell your HIV team about all supplements and herbal remedies
Read more: Hepatitis B and HIV | Hepatitis B treatment | Alcohol and HIV
Frequently Asked Questions
Can hepatitis C be cured if I have HIV?
Yes. Modern direct-acting antivirals cure hepatitis C in over 95% of people, including those with HIV co-infection. Treatment is free on the NHS.
Do HIV drugs damage the liver?
Most modern ART is well tolerated by the liver. Some older drugs caused more liver stress. Your clinic monitors liver function routinely to catch any problems early.
Should I stop drinking alcohol entirely?
If you have hepatitis co-infection or existing liver damage, abstaining is strongly recommended. Otherwise, staying within UK guidelines (14 units per week maximum) is advisable.
Related reading
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
- Can You Die From Hepatitis B?
- What Is Hepatitis A?
- What Is Hepatitis B?
- Hepatitis B Core Antibody Test Explained
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
