i have been positive for about a year, and have swollen lymph nodes that go down occasionally, but are swollen for most of the time. I have a CD4 of 615, and a very high viral load. I am not on meds. Should i be worried?

Swollen lymph ndes in the head and neck area are common and as long as one is not especially large sore and growing and you are not experiencing other symptoms, they are not likely to be of significance. Some guidelines suggest symptomatic disease regardless of CD4 (and especially with a high viral load) that you may consider starting treatment. This would likely reduce your lymph nodes. If the START study is available in the new year at your treatment centre, this may also be an option for you, the study is investigating the potential benefits of early versus standard timing for treatment initiation.

I hope this helps Kind Regards Dr Moyle