Your first combo - when and what

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The new HIV treatment guidelines just issued by the British HIV Association (BHIVA) recommend starting the drugs later than ever before, and for the first time recommend starting with a particular sort of combination.
They now suggest starting when the count falls below 200, unless the viral load is high or people have symptoms. The guidelines state: "There are good reasons to delay therapy in order to minimise long-term drug toxicity and the development of resistant virus."
BHIVA does note that people whose CD4 counts have never fallen below 350 seem to be less likely to develop the Aids-related cancer lymphoma. (Hepatitis C is easier to treat at high CD4 counts too, so hep C co-infection could suggest earlier treatment.)
The guidelines come out cautiously in favour of starting with an initial regime of a non-nucleoside or NNRTI - usually efavirenz or nevirapine - plus two nucleoside drugs (AZT, 3TC, d4T, ddI, abacavir etc). They state: "Many clinicians now favour an NNRTI-based regime for initial therapy, reserving protease inhibitors for later use and three nucleosides for patients...perceived to have major adherence difficulties." Professor Brian Gazzard, BHIVA chairman, explained the thinking behind this to a

National Aids Manual forum at the University of London last month. "We