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INTERVENTION/VIRAL LODE
Jul 28, 2002

mY BROTHER WAS RECENTLY DIAGNOSED WITH hiv, SINCE THEN HE HAS NOT TAKEN THIS SERIOUS. hE IS MISSING DOCTORS APPTS. AND HAS NOT TAKEN ANY MEDICATION. i HEARD FROM A FRIEND, THAT WAS CONTACTED BY MY BROTHERS DOCTOR THAT HIS CD4(t-cELL)COUNT IS BELOW 100.

iS THERE ANYTHING I CAN DO TO MAKE HIM GET TREATMENT.iF HE REFUSES, WHAT ABOUT FAMILY INTERVENTION? mY BROTHER ALSO IS CLAIMING THAT HIS VIRAL-LODE COUNT IS VERY LOW BUT HIS T-CELL COUNT IS GOOD. IS THAT POSSIBLE AND WHY?

Response from Dr. Young

Thanks for your question and sorry to hear about your brother.

There are a couple of issues that you raise. Firstly, it would be important, for point of discussion, to confirm exactly what your brother's CD4 count is. If really (and confirmed) below 100, then starting HIV therapy would definately be recommended. If higher, say about 250, then imminent starting is less critical.

The second issue is related to the issue of patient autonomy and confidentiality. Provided that your brother is mentally competent, then he is the one that decides his medical care and who has access to this information. He would also be the person that decides on when he goes to his healthcare provider and what medications to take (or not). In this light, to force him to do otherwise, is actually tantamount to assault, despite better judgement.

In these circumstances, I'd work with your brother with support networks, patient education about the risks and (potentially life-saving) benefits of therapy. Getting him to his doctor's appointments alone would be a useful first step, since missed appointments usually correlate with missed doses of medications (and subsequent risk of premature treatment failure). Good luck, BY



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