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dying with AIDS
May 17, 2009

We were told by a doctor in the hospital that our cousin, whom my wife and I are responsible for, is HIV+. In the past 12 months he has had 3 heart attacks, the first 9 months ago and two in the past 30 days, while in the hospital. Most seriously he suffered a major respiratory infection and was in isolation for nearly two weeks. He was discharged to a nursing home but within 48 hours readmitted to the hospital for the lung infection. He has lost considerable weight (going from 155 to 120lbs), he suffers from fatigue and hasn't walked on his own in 3 weeks. He is also experiencing dihhera and has lost control of his bowel. So, while the doctor said he was HIV+ no one, including him, will confirm his status or provide a prognosis for his recovery and should he recover how long it may take. Any insights you can provide will be appreciated and helpful. Thank you.

Response from Dr. McGowan

This is a difficult situation since there are issues about disclosing his HIV+ status and discussing what is going on with your cousin. He seems to be reluctant to discuss what is going on with him and he is most likely extremely scared and worried. Your ongoing support is critical during this time. In terms of helping you sort how he is doing, you need to know his CD4 count (which is white cell in the body that HIV infects and over the course of HIV infection, the CD4 cells in the body decline) and his HIV viral load (or the amount of HIV in his system). The CD4 count gives you a sense of the strength of his immune system and the viral load gives you a sense of how much virus is replicating within his system...the higher the viral load the quicker the CD4 decline over time. I think given the fact that he appears to have symptoms from his HIV infection, that he will most likely need anti-HIV treatment. I think if he is able to start a potent anti-HIV combination of three active HIV drugs, and remain adherent to this regimen, he should have an excellent response both in terms of getting the HIV down to what is termed "undetectable" levels and improving his immune system by increasing his CD4 count. Improving his CD4 count will reduce his risk of getting complications from the HIV infection. Estimating life span is not always easy, but there was one study from Europe that estimated that an individual diagnosed in his/her 20s with HIV who starts appropriate treatment at the appropriate time, would have a life span that stretches into his/her late 50s, early 60s. The estimates of life expectancy with HIV continue to rise each year. The most important thing you can do is not to despair, keep him in care as you have done, encourage him to consider anti-HIV treatment if his symptoms are HIV-related, monitor the response to treatment carefully and retain a positive attitude. Best of luck Joe



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