My friend "Sam" was tested for HIV three years ago and was never treated. As of 2 weeks ago, Sam was diagnosed with AIDS, with his cd4 count being 44 and his viral load being over 750,000. His doctor was extremely concerned because Sam just started a new job, and is not eligible for health insurance yet. The doctor really wants him to quit working so that his health can be a priority, but he refused. The social worker and I tried to get him to be receptive to other alternatives such as ADAP, but Sam refuses to release any personal information for fear that his privacy will be compromised. It was also suggested that he try to get some psychiatric help in coping with this, but again he refuses. Yet he says he's coping fine. He's only had two appts and already is out of a couple thousand dollars in bills because he's paying out of pocket. The doctor gave him two medicines to take to try to help him immediately, but now Sam is saying he doesn't want to take one of them because of the side effects (dizzyness, being lethargic, etc), and that he can't miss any more days of work. Worse still, is that Sam is living at home with his parents, who not only don't know that he's gay, but they also don't know just how sick he is although I'm sure they suspect it with his extreme weight loss, fatigue and constant diarrhea. I really don't know what to do to help him, and I'M the one who's scared now. I have tried to be as supportive as I possibly can, but this point, even I don't seem to be getting through to him. Is there any advice you can offer for loved ones who are trying to help someone with this awful disease? With his test results this low, how bad is this going to get for him, if he can't make it to the doctor (because of the bills) anymore until his own insurance kicks in? I want to be as realistic as possible, so my last question is: are there things legally he should have in place in case his condition worsens and he doesn't make it? Thanks for your response.

With such a low CD4 count and high viral load, his health is in very precarious condition. He is at high risk to develop an opportunistic infection. He is at risk to develop memory and neurological impairments. He is at risk to develop metabolic complications such as dehydration and electrolyte disturbances due to the chronic diarrhea.

I don't know what else you can say to him to change his mind. He seems quite determined to do this his way. I imagine he'll continue like this until he becomes too ill to continue to work. At that point he will need to decide what treatment he is willing to undertake, and explore the available resources (like ADAP, etc.) to help him get the treatment he needs.

In terms of your legal question, at some point he should execute an Advanced Directive, which includes a written statement of what medical treatments he would like if he should become unable to make decisions (for example, does he want to be intubated or have cardiac resuscitation). Judging from his reluctance to take action right now, he is not ready to engage in such a discussion yet. If he should become ill, you will need to bring these issues up as soon as possible.