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Can we make him get help?
Jun 10, 2002

My 37yr old brother has been positive for over 10 years and refused HIV treatment. He has a T-Cell count of under 60. He is 5'7 128lbs (was 145lbs). His face is gaunt and he sleeps most of the time.

He was diagnosed with a fungus in the lungs and throat last week. All this and he refuses to take ANY meds. Not even to treat his sore throat and lungs. Can this lung fungus kill him?

He's been a life long cocaine addict and the moment he feels better resumes to abuse cocaine.

Can we forcebly hospitalize him? If not, realistaclly how long can he survive this way?

Response from Dr. Young

Thanks for the question. Sounds like a tough situation.

Fungal lung infections can be very serious, sometimes fatal (depending on the species of fungus). Certainly with a CD4 count of 60, without HIV and anti-fungal therapy, your brother's prognosis is, frankly, grim.

The decision to force someone into treatment against their will is difficult-- requires a statement of incompetency-- usually by a psychiatrist. His active substance abuse may be an avenue to making this determination, but also would appear to be a way to bring him into psychiatric care.

If one is unable to initiate effective therapies, an alternative approach (and equally caring) is to suggest hospice care (either inpatient or home). In this setting, at least his emotional and analgesic care can be optimized.

Good luck. BY



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