Hey Duncan --

HIV and CSA. Welcome to the club (a long read, but wtf):

PM me any time. At 20+ years, I suppose I'm one of those "long term progressors". imo, though yes, the cycling helps physically and mentally (used to be a runner, one of those who'd cry uncontrollably after a 5K or 10K), it's not a panacea.

My two cents'. Take what you like...or none of it ;-)

Your CD4s are like an alarm system that alerts the CD8 cells (police, essentially) to respond to infection. Normal is 500-1600 or about 40% of your lymphocytes. HIV disables/destroys the alarm system and there's reduced immune response to infection. HIV doesn't care if you're a marathoner or if you sit on your fat bum eating crumpets! laugh

First line of defense is to disable or destroy the HIV "bad guys". Your viral load is an indication of how many bad guys there are. Ideal is "undetectable" which only indicates the limits of the screening system. Current limitation is about 50 copies per cubic mm of blood. A newer assay gets it down to about 5 copies. A more reliable indicator is the CD4%, less subject to short term variations. Breakpoint is about 17%.

Typically, my barometer has been based on how I feel instead of the numbers. But my numbers got really bad, the evidence being the number of infections (fungal, shingles, etc.) and increasing fatigue.

I can't speak for the UK, but the CDC here likes to see HAART (highly active antiretroviral treatment) start at a count of 350 and, at the latest, a CD count of 200. Ugh...I started a protocol this year at 33 and 2.4%. But I'm now undetectable and the CD4 is rising, slowly.

And, y'know Duncan, it's just information to have. If you want someone's unsolicited (probably useless and patronizing) opinion, ask your auntie! (No offense; she's probably a delightful woman). Naturally, if you're not feeling any adverse effects yet, I can understand why you'd be reluctant to start meds. If you're inclined - lol...probably not! - you might want to find out what your HIV genome is and options for treatment when/if the time comes. Mine is a once daily combination therapy and I had only mild, temporary side effects that lasted a few weeks. Trick was to become completely obsessive about sticking to my dosing schedule - hell, after years of working to overcome OCD? wtf? - and not missing even a single one. smirk

Repeatedly starting/stopping any treatment, however, is a bad idea. HIV becomes resistant more quickly. Put another way, it's best if you're either in or out. A case where all-or-nothing is actually a GOOD thing.

One inexpensive, clinically-proven alternative is Selenium (200 mcg):

I've used it for years, since the study was published, along with the usual multivitamin routine.

Love the Hellraiser puzzle box, btw