SPECIFIC AIM 2) To determine the impact of high-level alcohol use on the relative long-term benefits of immediate vs. early vs. delayed ART initiation. High-level alcohol use results in changes in the GI microbiome, increasing dysbiosis and gut permeability, and these changes are associated with up-regulation of inflammatory pathways (8-13). Dysbiosis is present in many HIV-infected patients. The extent of dysbiosis correlates with established markers of HIV disease progression and the consequent inflammatory processes contribute to HIV disease progression, even in treated individuals. Methods: The investigators will use monthly data on alcohol use to assess alcohol consumption as a continuous, time-varying predictor. In all participants at the time of diagnosis, and at multiple timepoints prior to ART in those enrolled into the deferred group, they will assess VL, GI microbiota and metagenomics, pro-inflammatory cytokines, and production of msRNA. They will compare these factors between subjects by their reported alcohol use, focusing on events occurring shortly after HIV acquisition. Specimens from uninfected and chronically infected subjects are available as controls. Finally, among ART-adherent subjects with persistent viral suppression, the investigators will assess inflammatory markers and HIV reservoirs in those with and without high-level alcohol use at 1.5 and 3.5 years after ART initiation.