This question comes up a lot but some of us are still a bit confused. I have a virus in my body and I am not sure what it is doing right now. Most doctors say don't treat until CD4 gets to around 350 to even 550. What if CD4 levels are fairly good... say more that 550...maybe 650...maybe more...what is the rationale for not treatment even at higher CD4 levels?. I keep reading that the new drugs like Atripla have few side effects so that shouldn't stop the treatment from starting. If I am going to be on treatment for many years, why go 6, 12 18 or more months with no treatment at the beginning?.Is it because the treatment requires diligence,,,,lots of people take pills daily. Perhaps resistance to the drugs is a factor.. Please help me and others understand why treatment doesn't begin immediately and perhaps keep CD4 level in a better place. Maybe I am missing some information. Thanks for taking the time to answer all the questions that come your way. It really helps us. I look forward to reading all your responses.

Hello and thanks for your important question.

You are correct in that newer treatments have far fewer side effects than older ones; it's this reason that we can now consider treatment earlier in the natural course of HIV infection than in previous years.

I also think that your summary is right that if you're going to be on medications for years, sparing a few months on the front end (and perhaps risking additional complications) doesn't seem like a good investment.

Rather, I think that the preponderance of evidence suggests that it's generally a good idea to prevent HIV from causing damage to the immune system; hence starting treatment with higher CD4 counts is reasonable. More so for persons who are older (and at greater risk of HIV events and less CD4 count improvement) or for those with other medical conditions.

Yes, taking medications is never trivial, nor the right thing for all persons. Failure to adequately adhere to treatment comes with the irreversible risk of developing drug resistance and medications require monitoring for side effects and toxicity. But, taken as a whole, if I was infected, I wouldn't be waiting too long to start on treatment and would take a very individualized approach to figuring out what the best medication regimen for me (and my virus)is.

I hope this helps and wish you well,

BY