Objective： To assess changes of liver function in HIV-positive children with/without HBV/ HCV co-infection after 1 year of highly active antiretroviral therapy (HARRT). Methods： Seventy-eight pediatric AIDS patients with HBV/HCV co-infection，19 pediatric AIDS patients with HBV co-infection and 44 pediatric AIDS patients without HBV/HCV co-infection who received HAART at least for 1 year were enrolled. HIV-1 viral load was quantitatively detected using a standardized reverse transcriptase-polymerase chain reaction assay, and blood cells were determined by three-color flow cytometry. Anti-HCV antibody and HBsAg was detected using an enzyme-linked immunosorbent technique, and ALT, AST and TBIL were detected by automatic biochemical analyzer.Results： After 1 year-HAART, the viral load was decreased to the lowest limit of detection in 90.34% patients (t=2.61, P<0.01), and CD4+ T cell counts were increased from 170.187±132.405/ μl to 796.014±158.491/ μl (t=3.17, P<0.01). The levels of ALT and AST were elevated (t=2.02, P<0.05), while the ALT and AST levels in patients receiving nevirapine (NVP) based HAART increased from 18.28±13.74 U/L and 24.23±8.09 U/L to 55.35±22.40 U/L and 69.97±26.72 U/L, respectively（t=3.80，t=4.11；Ps<0.01）. The increment of ALT and AST in NVP based HAART were significantly higher than that in the efavirenz based HAART (ALT: 46.28±13.35 U/L vs 37.70±15.25 U/L and AST: 19.53±7.23 U/L vs 1.25±0.21 U/L, respectively; t=4.53, t=5.79; Ps<0.01), particularly in patients co-infected with HIV/HBV/HCV （ALT:54.32±22.85 U/L vs 16.89±14.42 U/L and AST: 41.71±19.26 U/L vs -3.44±15.59 U/L, respectively; t=3.42, t=2.98, Ps<0.01).Conclusion： HARRT can repress HIV-1 replication effectively, but it also cause the damage of liver function, especially in patients with HBV and/or HCV co-infection.