I have been hiv positive for less than a year. My recent labs results were CD4=348 VL=12000. My doctor said it was my decision whether to start the meds but if it were him, he would go ahead. He prescribed Truvada/Sustiva. I've read a lot about not starting meds until necessary so I'd just like a second professional opinion if I should start the meds. I'm a 42yo healthy male with no other health conditions. I fear the Lypodistropy(??) side effect. Has that been reported with Truvad/Sustiva? Thank you for taking the time to read this. I'm still very scared of this disease and fear starting the meds although my doctor said they are very effective and I should preserve my immune system before it gets too compromised. Thanks again!!

The decision as to when therapy should be started remains controversial. In general, most would agree that treatment should be initiated whenever possible in those with consistently less than 200 CD4 cells. Many HIV specialists start to discuss the potential role of therapy when CD4 cells are consistently less than 350. You are in the range where it is reasonable to consider starting but also not necessary unless CD4 cells continue to decline.

If you were to start therapy, Truvada (viread with FTC) and sustiva would be one of the preferred options and certainly reasonable. Although we don't completely understand why lipodystrophy develops in some and not others, at this time it is not thought that any of these drugs are likely to contribute to this problem. That said, there remains much we don't know about lipodystrophy and there are no guarantees.

Best, Eric