Dr. McGowen, You answered the question(s) I posted regarding my cousin and I want to thank you! A lot has changed since I asked the question including input, Q&A and assistance from his physician. First & foremost for the past 10 days he has had one consistent physician. My cousin does have in-stage AIDS and a CD4 count of 20. As I mentioned in my initial question he has suffered three heart attacks since February 2008 two of those in the past 30 days; he has suffered from a major respiratory infection and most recently near kidney failure (and the doctors feel that diaylsis may still be required). Most disturbing has been his loss of cognitive function and when he speaks its gibberish; he intermittently can recall someone's identity but most of the time his eyes are closed and his face without expression. I ommitted that he is 57 years old and is NOT receiving any medicine for his HIV-AIDS. I have tried to figure out how long he's known that he was HIV+ and my best guess is 1 1/2 to 3 years. I think he was in denial and that's what has brought on this onslaught of illnesses. His doctor gives him 6 to 12 months and that's if he regains his appetite and eats, and if he takes his medication (none of which currently is AIDS related). At his age and with his advance condition - renal, heart & respiratory - is there any chance for him to be able to care for himself or will he need intensive nursing for the rest of his life? I truly value your objective second opinion! Thank you.

I am sorry to hear how bad things look for your cousin.

His condition is complicated by many factors that may determine his overall prognosis. These include: the damage done by the heart attacks to the function of his heart, the cause of his kidney disease (related to HIV, or shock after his heart attacks, or medication toxicity, etc), the cause of his mental status change (HIV related, due to shock, strokes, or due to kidney failure).

Since his CD4 count is so low, it is possible that untreated HIV infection may be playing a role in some or all of these complications. Depending on his ability to take medications I generally try to suppress the HIV if possible. HIs long-term prognosis will depend on strengthening his immune function. Treatment wuld have to be based on his heart disease risk factors (high cholesterol, diabetes, etc), his kidney function and the other medications that he is on for his heart and lung disease. If his organ damage is end-stage then it may not be possible to turn things around. You should have a frank discussion with his doctors and try to plan treatment that would be in the best interests for your cousin and his future functionality.

Best, Joe