PreP and Liver Disease (Fatty Liver or NASH)

[Littlebill77]

On 4/25/2021 at 5:59 PM, Leathercouple said:

Never posted before but like the discussions and dialogue on this site. 
I started PreP approx 2 yrs ago but I don’t take it regularly I.e. I dose up for vacations and weeks like Folsom etc, taking the meds for 7 days before events/sex, during (could be a few weeks of off and on sex, and then 7 days post last raw encounter. I am 100% top.

Blood work done every 4-6 months. Sometimes more frequently. Each time there was slight elevated  liver enzymes. Nothing was made of them as kidney and bone markers were fine. Just told it was from having a few beers over weekend. Though I drink not so much. 
 

Ever before starting PreP I had unknown cause IBS. Attending a gastroenterologist and had a recent liver and gall bladder ultrasound as part of the IBS checks. out of the blue last week he told me that the ultrasound came back with severe fatty liver evident. 
going for a fibroscan this week to see level of liver impact/disease. I asked what he thought caused it. But he said he didn’t know. Then I start looking into Truvada/PreP and suddenly see now that elevated liver enzymes, fatty liver disease and NASH are known side effects of these drugs. 
During all my discussions with true PreP clinic it was never mentioned as a risk - it was all about kidneys and bone. 
 

Really worried now that I have damaged my liver. What are peoples experiences? Could it be a coincidence and nothing to do with the PreP or ?

concerned Irish! 

I had elevated proteins (kidney function) that we put down to a stint on Keto 

medico was more concerned as it interferes with a blood pressure medication I take. Was doing a blood test extremely regularly and it went back to normal.

tl;dr are you doing a high protein/fat diet?

[TakingItDeep]

I'm poz and the pills mess with my liver levels occasionally, just had to change them again because of it. 

[Leathercouple]

New test results show 2/3rds fatty liver but no other damage. Looked back at blood work prior to Prep and since and there is a correlation to when I started on the Prep. Disappointed now as my bb days are over as this PreP won’t be good for me. Hopefully something new comes down the line soon. 
Thanks to all for the info and advices. 

[BootmanLA]

6 hours ago, Leathercouple said:

New test results show 2/3rds fatty liver but no other damage. Looked back at blood work prior to Prep and since and there is a correlation to when I started on the Prep. Disappointed now as my bb days are over as this PreP won’t be good for me. Hopefully something new comes down the line soon. 
Thanks to all for the info and advices. 

One thing you might consider: see if you can find out exactly which of the components of the PrEP medication you were using has the liver side effects, and see if your doctor is willing to prescribe something else - possibly something used for HAART - as an alternative. If the costs are similar, he might be able to get your insurer to pay for the alternative medication as an alternative use. *might* be a long shot, but it's worth asking.

[austin_submale]

So a person with fatty liver can't take PreP?

 

 

[fskn]

2 hours ago, austin_submale said:

So a person with fatty liver can't take PreP?

This is a question for a doctor or other health professional licensed to provide HIV PrEP care.

Worth noting:

• PrEP no longer refers to just one type of pill. Two two-drug pills are already approved for PrEP in the US. Descovy has one drug in common with Truvada and another that has been reformulated. Injectable drugs, recently approved for HIV treatment in the US, have also been studied for prevention and are likely to be approved for this use soon.

• Serious liver side effects are rare in people who use Truvada or Descovy for HIV PrEP, and who do not also have Hepatitis B. Truvada was approved for HIV treatment long before it was approved for HIV prevention, so it's vital to distinguish studies of Truvada in HIV-positive people (who take one or two additional HIV drugs) from studies of Truvada in HIV-negative people (who do not take any additional HIV drugs).

The LiverTox database, from the US National Institutes of Health (NIH), is one place where anyone can read about the liver effects of drugs. The database references medical studies, which are much more reliable than individual anecdotes.

Here are links to the entries for Emtricitabine and Tenofovir, the two drugs in Truvada:

[think before following links] [think before following links] https://www.ncbi.nlm.nih.gov/books/NBK548261/

[think before following links] [think before following links] https://www.ncbi.nlm.nih.gov/books/NBK548917/

This is for interest only. Again, professional medical advice is in order.

Edited June 1, 2021 by fskn
Typo

[BootmanLA]

22 hours ago, austin_submale said:

So a person with fatty liver can't take PreP?

-coupled with-

 

19 hours ago, fskn said:

This is for interest only. Again, professional medical advice is in order.

Fskn's point is well-taken, but the answer to the question austin raised above is "Not necessarily".

The point of the poster's experience and research is that (a) the literature documents that fatty liver *can* be a side effect of one of the meds in Truvada, and that (b) he apparently is one of those who experienced that side effect.

That is not a statement that "everyone who takes PrEP will get a fatty liver" nor is it a statement that "If you have a fatty liver you can't take PrEP". For starters, "fatty liver" is not a yes/no thing; it's relative, and two people affected with fatty liver caused by the meds in Truvada may have that condition to wildly different extents; that is, one may have severely fatty liver and the other may just have it to a mild extent. Moreover, one might have a fatty liver already, not caused by PrEP, and at the same time be one of those people whose PrEP usage doesn't affect the liver at all, so PrEP presents no problems even though he's already got a fatty liver.

That's why it's important to get advice from a doctor. 

[Leathercouple]

Totally agree with all that has been posted. This is my personal experience with PreP. I’m one of the rare few where it impacted my liver function and caused severe fatty liver. 
The challenge now is that there is only 1 approved PreP med in my country - Truvada/genetic Truvada. 
All I would say to people going on PreP for the 1st time, is to have a baseline liver assessment  (ALT,ALK etc) that then get checked 3 or 6 or 9 months into use. 
My experience is that in general healthcare zones in on kidney and bone markers for impact when on PreP, but there are other factors that warrant checking too. 

[NEDenver]

On 6/2/2021 at 4:53 AM, Leathercouple said:

Totally agree with all that has been posted. This is my personal experience with PreP. I’m one of the rare few where it impacted my liver function and caused severe fatty liver. 
The challenge now is that there is only 1 approved PreP med in my country - Truvada/genetic Truvada. 
All I would say to people going on PreP for the 1st time, is to have a baseline liver assessment  (ALT,ALK etc) that then get checked 3 or 6 or 9 months into use. 
My experience is that in general healthcare zones in on kidney and bone markers for impact when on PreP, but there are other factors that warrant checking too. 

I'd say the bigger challenge is that if you become positive, what medications are they thinking of using that wouldn't have Truvada as part?

[fuckholedc]

Thanks for the info. Just prior to traveling to Berlin for the BiohazardMen party (April, 2023) my AST:ALT ratio went off the charts. My doctor actually said (in email) that my "liver enzymes were slightly elevated"!  Actually, no they were NOT slightly elevated - the ratio had skyrocketed.  He wanted me to stop Truvada - I told him that this is a really bad time.  Unfortunately he got really upset ... Started taking milk thistle.  However after this trip I will have to get off Truvada.  Are liver problems indicated with other forms of PrEP?

[BootmanLA]

8 hours ago, fuckholedc said:

Thanks for the info. Just prior to traveling to Berlin for the BiohazardMen party (April, 2023) my AST:ALT ratio went off the charts. My doctor actually said (in email) that my "liver enzymes were slightly elevated"!  Actually, no they were NOT slightly elevated - the ratio had skyrocketed.  He wanted me to stop Truvada - I told him that this is a really bad time.  Unfortunately he got really upset ... Started taking milk thistle.  However after this trip I will have to get off Truvada.  Are liver problems indicated with other forms of PrEP?

There are, at present, only two widely used oral forms of PrEP. Option one (Truvada and its generic equivalents) contains drugs A and B; Option two (Descovy) contains A and a slightly different (chemically speaking) version of B. The slight difference in the second drug does make a difference in some conditions. Truvada/generics should be avoided by people with osteoporosis, for instance, while Descovy appears to be safe for that condition.

With respect to liver issues: Truvada is known to sometimes exacerbate preexisting conditions with kidneys, and patients using it are generally monitored for both kidney and liver functions. I do not know that there is any evidence one way or the other as to whether Descovy presents the same issue, but it's an alternative your physician may want to consider.

There is also an injectable form of PrEP (brand name Apretude) that has been approved by the FDA. It's administered every other month instead of being a daily medication. I haven't yet found any data as to whether that medication is any more or less safe for liver issues.