Hello, Why is it optimal to begin treatment when a patient "gets close" to Aids rather then when they have mild immune suppression? Secondly, at what situation (ie cd4 levels, etc)does it become dangerous/lifespan reducing to continue to live untreated? Thanks

Thanks for your post.

Let's start with your second question-- it's dangerous not to be on HIV treatment when CD4 counts are below 200. This is because when counts are below 200, there is a very real and increasing risk of developing AIDS complications. Many of these are life threatening conditions.

As for when is treatment optimal? This is an area of debate, subject largely to the benefit of treatment vs the risk (or costs) of treatments. Not everyone agrees on these points and each patient has a different set of conditions that impact this decision. In my opinion, if the patient is willing and able to be adherent to treatment, then I offer treatment earlier ("mild immune suppression") rather than later ("dangerous") . BY