I have a CD4 count of 460 and 10,000 viral load. I'm not on meds right now. I've been on accutane before I had HIV and it did not effect anything. Is it ok to go on it now?

I don't think there is any problem to use Accutane in the presence of HIV infection and if you are not taking HIV meds. From a previous post of mine a couple of years ago: Accutane is not listed as a drug which is absolutely contraindicated with protease inhibitors. That said, PIs and ritonavir in particular, will interact with the same metabolic liver enzymes as accutane. One would generally think that accutane levels would go up with ritonavir co-administration, but I could not find conclusive evidence of this, and in fact the opposite was reported (only one patient) with indinavir, where the plasma levels went down. We also don't know whether plasma levels alone would be reflective of accutane toxicity. Caution is urged when taking both PIs and accutane together. To add further, there is little known about interactions with other classes of HIV meds.

Finally, just looking at your numbers, I don't think there is any rush to start HIV meds just yet. You are still in pretty good shape without them.