I am 20, and was infected 8 months ago. I guess that I have missed the window where by early treatment to preserve the T cell subset which activly fights HIV, by a few months. I know that starting treatment now will most probably keep me healthy (save the side effects) for the rest of my natural life, especially with a new once daily treatment in the pipeline. However, I don't want to start the drugs, because of the side effects, particularly the body fat changes. I am wondering if I should start treatment now, or concentrate on using alternative treatments to help my body fight the HIV, and extend the time I have before I have to start conventional therapy. I am hoping that If i can go for about 6 years before my T cell count gets below 400, and by then (hopefully), less toxic treatments will be available. The bottom line is that i'm not going to let the HIV kill me, but I don't want to comprimise the best years of my life with toxic drugs.

Thank you.

I think your approach of trying to stay healthy using your bodies own defenses until you "really need" to start treatment is in line with current thinking. It is the best advice I could give right now, although the issue of when to start will continue to shift around.

Given what we know today, 300 to 400 T cells is a good target range for starting. 200 is probably a little too late, but beyond that, we really cannot be too precise.

I do need to comment on the issue of toxic drugs and side effects. The pendulum has swung from one extreme of "these drugs are miraculous and there are no problems" to the other extreme of "the treatment may be worse than the disease." Both of these are exagerated positions, and the reality lies somewhere in the middle. We tend to get caught up in trends in the HIV world.

Toxicities are real, and for some, they can be quite severe and compromising. Others show no signs of significant toxicity after 5 years of continuous HAART. Those of us old enough to remember the world before HAART remember the horror of uncontrolled HIV disease, and lipodystrophy doesn't compare.

My message is to seek a balance. As long as your immune system is doing well, you don't need the drugs. However, don't be terrified of them if when the time comes. Take care of yourself in the meantime. Pursuing alternative and complementary ways to maintain your health is great, but there are some simple, unsexy things that matter too. Rest, excercise, good nutrition, quit smoking, no recreational drugs, avoid very heavy drinking, and avoid new sexually transmitted infections. Dull, but important stuff.

Good luck

ATP