Thanks for your post.
If I was caring for your patient (with a prior history of malignancy and with his CD4 counts), I would certainly recommend starting antiretroviral therapy. With his current CD4 count >200, there's no immediate indication for primary prophylaxis for opportunistic infection, but the time is close.
As for regimens for dysphagia, there's no absolute guidance. There are some medications available as exilirs; others with dysphagia prefer capsules to tablet formulation of medications. It would be worth understanding the basis of the dysphagia -- is it because of esophageal infection or residual tumor?
I typically monitor patients at baseline (CD4 count, viral load, diagnostic panel, resistance tests) and then most closely for the first weeks of treatment -- at 2 weeks, a check for side effects, dosing requirements and toxicity. At week 4, the first labs to verify viral load reduction and CD4 (the later is somewhat optional). I look for at least a one log (90%) reduction in viral load at this point. Labs and clinic visits are usually done every three-four months.
As for education, this is a big topic. The natural history of HIV disease, goals of treatment, risks and benefits of therapy; adherence, safe sex, safe drugs, doctor-patient relationship and communication skills; just to start. This takes investment of effort and time; for patients with web access, of course, TheBody.com is also of a lot of value.
I hope this helps, BY
