In last three months, my friend has taken D4T (40),3TC, NVP and some multivitamin. After that, his CD4 improved from 6 to 16 and his SGPT/ALT increase to 152. Should he changes the HIV med due to concerns about hepatitis? Can he survive as his CD4 is very low?

At that CD4 count, it is essential that he be on antiviral medication, as the key to his long-term survival is clearly the recovery of his immune system that will follow. As for the elevated liver function tests, I would not be concerned about the nevirapine, as the risk of drug-associated hepatic toxicity at such a low CD4 count is much less than 1%. These elevated liver enzymes may be due to reactivation of some hepatic infection or other condition that may have been present before he went on treatment. This is occasionally seen as the CD4 count rises, is temporary and will resolve. This being said, it would be important to continue to monitor the ALT over time (perhaps every 1-2 weeks) to make sure that it is not going up further.