hi sir i am 35yrs male recently diagnosed+ve.my cd4 is 500.til when approximately i can wait for my treatment to start.i stay in south india.what would be best combination drug to start

Hi from America!

Right now your CD4 count is quite good. In the US, we currently recommend starting treatment when the CD4 count is at 500 or less, so this would be a good time. If you have access to treatment and can stay on it without interruption (that will lead to the best long-term benefit) then you could start at any time now. Current WHO guidelines recommend starting treatment before the CD4 drops below 350.

There are several good combinations. We generally base treatment on 2 NRTIs (nucleoside reverse transcriptase inhibitors), such as the combination tablet tenofovir + emtricitabine with either a NNRTI (non-nucleoside reverse transciptase inhibitor), such as efavirenz (in your case you should not start with the alternate NNRTI, nevirapine, since your CD4 count is above 400 and this drug can cause serious side effects if started with a high CD4 count), or a Protease Inhibitor combination such as ritonavir + atazanavir or darunavir or the combination tablet of ritonavir/lopinavir.

These are all well tolerated over time, but you should have your liver and kidney function monitored while on treatment.

Best,

Joe