Thanks for taking the time to answer my question. I am about to start meds and find myself struggling to choose the right combo. My blood work from a week ago is; cd4 - 292, viral load is 572 and 33%. I sometimes have crazy dreams and are very intolerant to any kind of meds.

If you were my dr, what would you recommend I start with?

A missing piece of information is a resistance test to show if you had been infected with an HIV that may carry drug resitance. That would effect the choice of meds. If your virus has had no drug resistance, the current guidelines recommend choosing between 4 different options:

1) Atripla (tenofovir + emtricitabine + efavirenz), which is easy- 1 pill once a day, but may not be best for you because of "crazy dreams" which might get worse on this med.

The other options are truvada (tenofovir + emtricitabine) + either 2) ritonavir + darunavir (Prezista), or 3) ritonavir + atazanavir (Reyataz) or 4) raltegravir (Isentress). The first 2 of these combos can be given once a day, the 3rd is twice a day, which may make a difference for some people. Options 2 & 3 each contain ritonavir, which can cause upset stomach and some cholesterol problems for some people. If these kinds of effects are a problem for you then the Isentress although twice a day may be the best choice.

You should go over these options with your doctor and look at the pros and cons of each for you. Based on your counts the time to start is now. I have had people on all these combos and the vast maority do well on any of them, that is why they have made it to the top of the list.

Joe