Liver damage is a common problem for PWAs, yet few people know what this vital organ does. The liver cleanses the blood of dead cells, infectious agents and other toxins. It also helps break down fats, process nutrients and maintain blood sugar. When this organ is impaired, you can't handle drugs important for your health, your nutrient balance can be jeopardized and you may suffer hypoglycemia (harmful drops in blood-sugar levels). Among the causes of liver damage are repeated use of antibiotics, excessive alcohol and recreational drug use, viral hepatitis and several opportunistic infections.

The clearest way to diagnose liver damage, besides a doctor's physical exam finding abdominal swelling, is by detecting elevated liver enzymes and other measures on standard blood tests. Lark Lands, Ph.D., a nutrition educator and author of Positively Well: Living With HIV as a Chronic Manageable, Survivable Disease (Arbor Vitae/ Chicago), says, "Many people remain unaware of liver disease until it reaches a point that causes pain, swelling, fever or jaundice."

The first step is identifying and treating any infections that may be causing the problem. Next comes removing possible offending agents -- alcohol, non-medicinal drugs and (with your physician's advice) all but essential antibiotics. Dr. Paul Bellman, a New York City AIDS specialist, advises a "brown bag" checkup with your doctor to review all prescriptions and over-the-counter meds for possible liver toxicities and harmful drug interactions. He urges special attention to the risks of the new protease inhibitors. Lands also recommends decreasing chemically loaded junk foods and drinks and temporarily reducing dietary fats.

But to actually repair the liver, most doctors advise only watchful waiting -- while alternative medicine offers three time-tested, virtually nontoxic treatments. Alpha-lipoic (thioctic) acid is a powerful antioxidant rapidly depleted in a stressed liver. In Europe, it has long been successfully prescribed for liver regeneration after damage caused by hepatitis, alcohol or drugs.

The weed milk thistle has an active ingredient called silymarin. Taken in 80 percent extract form, silymarin is both a liver protector and an antioxidant whose chemical function is well researched. "The combination of thioctic acid and silymarin has reduced elevated liver enzymes in many of my clients, even those with chronic liver problems," says Lark Lands. "In fact, some have used this combination to lower enzymes enough to get into clinical trials of AIDS drugs in which high levels would have excluded them." According to Lands, the two remedies, taken daily, often achieve results within a few weeks, but she recommends long-term usage to prevent ongoing liver damage from the raft of common AIDS drugs.

Finally, the licorice-root extract glycyrrhizin is an approved Japanese treatment for chronic liver disease. According to Fred Bingham, long term AIDS survivor and director of Direct AIDS Alternative Information Resources, a New York City buyers club, "Clinical studies in China and Japan show that glycyrrhizin acts as a broad-spectrum antiviral and controls the inflammation present in viral infections. It also is a potent detoxifier, binding and removing toxins from your body. But when taking this product, be careful to monitor your blood pressure and potassium level."

So help for the over-stressed liver is available. Lands emphasizes the importance of prevention. "People should examine their risk factors, get regular bloodwork and tell their doctor if they have suspicious symptoms."