what is drug resistance and opportunistic Infection? I have HIV positive for 6 years now but yet to start ART. My CD4 count at the moment is 241 from 168.

These are very important issues for people living with HIV. Opportunistic infections are diseases that take advantage of an immune system that is out of balance due to HIV infection. They are called opportunistic because they are usually not capable of causing diseases in people with normal CD4 cell function, but can be very dangerous when the immune system is not functioning well. Some such infections are fungal infections (Pneumocystis jirovecii (PCP) pneumonia, Cryptococcal meningitis) or bacterial infections (Mycobacterium avium intracellulare) or parasites (toxoplasma infection of the brain, or cryptosporidial intestinal infection). These opportunistic infections mostly occur when the CD4 count is low (usually below 200). The most important way to keep the CD4 count up is to keep HIV suppressed with medications. Since your CD4 count has been below 200, it is important to discuss starting treatment and also to take medications to prevent opportunistic infections.

Drug Resistance is one of the most important issues in treating HIV. The virus's ability to become resistant to medications (which means the virus can still grow even in the presence of the medication) is the reason we have to combine 3 or more medications together to successfully treat HIV. The virus can become resistant to most single and double drug treatments. The main way to prevent resistance is to fully turn off the ability of the virus to grow by combining drugs together. If the virus cannot grow, it cannot mutate (make changes to its genes to overcome the effect of the meds). When you are taking medication you must take it every day to prevent resistance from developing by keeping the virus suppressed at all times.

Joe