My husband was diagnosed HIV+ this year in Febuary. His numbers are good with cd4 levels of 614 and viral load 22,100. He and his HIV specialist have signed him up for a study that is looking at the effectiveness of certain drug combinations on newly diagnosed individuals. He is due to start treatment next week. I have mixed feelings about him starting tratment this early. I have read the new guidelines and according to them he does not require treatment yet. I am very concerned about long term side effects and the possibility of developing resistence. My question to you is: 1. In a patient who is compliant and on triple drug therapy, how soon might one begin to have resistence? 2. At what point in treatment do people begin to have side effects? 3. How common is facial wasting and lipodystrophy/lipoatrophy and how long are most people on medicine before these side effects occur? Thanks, Concerned Wife

You have asked a number of important questions. The decision to initiate antiretroviral treatment is highly individualized, and you are correct in concluding that recent recommendations have become more conservative. The optimal choice for your husband is not clear, and either starting therapy or delaying with close follow-up could be reasonable strategies. With regard to resistance, the key is to achieve a virologic remission, ie plasma HIV RNA level <50, and this delays any resistance. Encouraging him to maintain adherence with his pills is crucial. Side effects such as lipodystrophy are more difficult to predict, but do not occur in many patients on their first regimens. I strongly support your advocacy for your husband, and developing a good method of communication and collaboration with his doctor will lead to the best long term outcomes.