Dear Dr. Sherer, I have had HIV, as far as I know, since 1991, I discovered that when I was rushed to the hospital for developing Diabetes. I have been very healthy and usually do not even have colds or flu,I take my flu shot and have had the phnemonia and hepititis shots. My latest Cd4 count is 660 and viro load is 50,000. 5 yrs ago it was at 1100.

My Doctor wants to start me on Truvada, Rexataz and Norvir. He tells me it is a good time to start because this will drop my viro load to undetectable. Trumada is some what new, When is a good time to start and is this a good combo? Also will help keep my Tcell count stabaized and can one survive at 660 cd4 count if it stays there or is realty it just slows the process.By the way I also take exforge for blood pressure and cholesterol medication as well as the insulin, my liver and kidneys are in great shape. I weigh about 200, 5'8".47 years of age

Thank you for your time nd have a save and Happy Holiday

Tom, South Carolina

The new HHS Guidelines of 12.1.07 advise that all patients with CD4 cells below 350 cells/ml be treated with ART. They also state that ART may be warranted SOME patients with CD4 cells above 350; for example, a baseline viral load above 100,000 is associated with a higher risk of HIV disease progression, and is an additional consideration.

In your case, your doctor may be concerned that the viral load is increasing, even if it is not above 100,000, and that your CD4 cells may decline more rapidly now than in the past. Together you can review the past trends in your CD4 cell count and viral load, as well as your resistance test results, to make the determination that treatment is warranted, and to choose the optimal regimen for you.

His recommended choice of ART is among the 'preferred' regimens in the HHS guidelines for initial therapy - it's a good choice, and there may be several good alternatives, depending on your resistance test outcome and the side effects that you might anticipate with the various options.

In sum, the choice to start ART is up to you and your doctor. I urge you to take your questions and concerns to him at your next visit. You can reasonably ask about the risk of staring now compared to the risk of not starting treatment, and about the option of waiting another 2-3 months before starting.