dear dr. McGovern,

Thanks for answering my question. It is very kind of you. About the hiv medications: could you possibly tell me which ones are liver friendly? I have heard that it is very difficult for people with liver problems, and hiv. I am so worried that the medications will damamge my liver to a point where it will not function anymore.

Thank you for taking the time and trouble to reply.

Sincerely, Yoshimi.

For persons with HCV or HBV, tenofovir and emtricitabine (eg, Truvada) is a great example of some medications that are "liver friendly". They do not cause mitochondrial toxicity. Truvada also has activity against hepatitis B in those patients who are infected. Abacavir and lamivudine are also well-tolerated pairs for the ART "backbone"...

Of course, every patient with HIV should also take a third drug. In the US, we recommend efavirenz, ritonavir boosted atazanavir, ritonavir boosted darunavir, or raltegravir. These medications are usually well tolerated from a liver point of view, but serial monitoring of liver tests are indicated. Also you should call your doctor right away if you have right upper quadrant pain, nausea, vomiting, fatigue, or jaundice, which can be signs of toxicity.