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Is this the End?
May 2, 2004

I have a 22 year old cousin who has AIDS, he was infected as a toddler due to blood products he received because he is a hemophiliac. He recently admitted himself to the hospital with a high temperature, extreme jaundice, and swollen lymph nodes. Tests showed that he has infections in his gallbladder, liver, and spleen. He also has pneumonia. The doctors have him on very strong antibiotics through a central line. Unfortunately, the jaundice has not improved and the lymph nodes are still swollen. The doctors are obviously concerned with both problems. Being a Hemophiliac makes it more difficult for the doctors to do a scope and biopsy the lymph nodes and liver. He is a stubborn young man and is very secretive about his health. With the new privacy laws it is very hard for his mom to get any information from the doctors. We did find out that his T-cell count is at a very scary level of six. Our questions are: Are there ways at this point to bring his T-cell count back up? Do the swollen lymph nodes and jaundice mean that he is at the end stages of AIDS? And I know this isn't a question that really can be answered but can you give us an estimate on how long he might have and if it is time we get hospice involved? Our family loves him dearly and any answers you could give use would be greatly appreciated. Sincerely, Jen Martin

Response from Dr. Young

Thank you for your troubling questions.

It's very difficult to provide any detailed questions, since each patient (particulary those with active AIDS complications) have different issues.

That said, current therapies for HIV and its complications are very successful in restoring health, even for those with very advanced disease, like your cousin.

Agressive and immediate treatment for HIV (we've even given HAART medications to persons on mechanical ventilators) can improve things, so if there's no evidence of drug resistance (I'm assuming that he's recently diagnosed), there is good reason to think that it's not time for hospice. I have a patient who a year ago was even sicker than your cousin (CD4 count ~10, with multiple active complications) who is now back to work, with CD4 count ~200.

This is not, by any means a guarantee, but I hope this helps. BY

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