A family member has been recently diagnosed with AIDS. His CD4 count is 80 but only contracted the virus just over two years ago. He is now on Truvada and Sustiva, with ABx and is waiting for chemo for the KS which is only on the skin. He is 55 and we don't really know how he will progress and whether we need to plan for a terminal illness. Please help.

I am sorry to hear about your family member. He is on a good choice of meds and as his CD4 rises and the chemo works, his KS will regress and new lesions will stop appearing. Sometimes new lesions get unmasked by inflammation as the immune system recovers, so allow, say, 6 months for the cessation of new lesions. This is not a terminal illness situation. This should be seen as a potentially serious issue that is now recognised and being treated. Your relative will begin to recover more full health. Some of the KS lesions will leave stains on the skin where they have been, but will otherwise flatten out.

CD4 recovers more slowly in older (>40) folks but it would be reasonable to expect a gain of 100 cells in the first year and maybe 30 each year after that, so it will be a while before his CD4 gets back to normal. His doctor will regularly monitor things like his kidneys and cholesterol, so he should get very good medical care going forward and can start working on delaying/preventing all the common disease of aging, the things that will affect his life in 20 or more years.

Hope this helps,

Dr. Moyle