If a patient has hep C and HIV what will you tell them in regards to how the HIV meds will affect their liver function?

All individuals with hep C and HIV should ideally be on HIV meds. Having chronic hep C is a reason to achieve a non-detectable HIV RNA (viral load). This may help slow the progression of scarring in the liver. So I tell people that HIV meds are beneficial and essential when there is hep C infection present. This is now the standard of care.

Years ago when the HIV epidemic began, some of the earliest HIV medications were not great for the liver. Worries about liver toxicity emerged, and were of concern. However we do not in many places in the world, have to use these older meds. People with both hep C and HIV should ideally avoid certain meds such as ddI (didanosine)and d4T (stavudine). These may cause fatty liver disease. DdI is associated with other concerns include non-cirrhotic portal hypertension. If a person has been on these meds in the past which is common, monitoring the liver over time for complications of fatty liver disease and for portal hypertension is important. There are some other older meds that caused problems for the liver but the newer generation HIV meds are liver-friendly overall and benefits greatly outweigh risks. Remember that some HIV meds (for example truvada) pass throught the kidneys and are not metablolized by the liver.