My youngest brother just learned he is HIV positive. No other labs have been drawn yet because of the holidays. Needless to say we are all devastated. The state where we live will only begin treatment after his t cell count has dropped below 350. I am concerned that he should be started sooner and have researched some clinical trials that he might be eligible to participate in (only because he has not yet taken any of the antiviral drugs). However, some people I have talked with do not think its a good idea to start taking the medications immediately. The information available is confusing and we are not really sure what he should do. Any suggestions would be greatly appreciated.

There is some debate about the optimal time to start antiretroviral (ART) meds, but there is general consensus that people with no symptoms should start ART meds only after the CD4 T-cell count falls below 350. There is little benefit to starting earlier, and the medications have significant long-term adverse effects. By starting later rather than sooner, one decreases the time of exposure to these meds and decreases the likelihood of adverse effects (like lipodystrophy, etc.).