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Sad news(Ecuador)
Jul 25, 2006

Friendly Dr Bob. I wrote you before about this patient from Ecuador (a relative of mine), the sad news is that he passed away, yet I have a question that bounces in my mind. When an AIDS patient have gone so far that his CD4 drop to 2 is the any chance for him to recover and survive using the retroviral meds or when it is so extreme there is no chance or is like a lottery the opportunities of recovering? In appearance he was doing better, he even got out of the hospital and started feeding and recovering some strength but one day he appeared with varicella (chicken-pox), the doctor told him it was the same virus he got it in his childhood that reactivated, because of this his throat was so soar that couldnt eat neither take the medicine, so he went back to the hospital to get fed and medicated trough his nose (or something like that, I dont know exactly the details) I visited him and he was recovering and feeling well again but all at the sudden he got a brain infarct with convulsions etc. The infarct wasnt to strong and the brain damage was little and seems like he was recovering a little again, started talking again (not clear), yet he had always phlegm (I believe pneumonia) after this he lived like a week till he died with septicemia. Did he have a chance? Or with the CD4 so low (2) there is no way back. All I can say is that I expect his soul is free of his decayed body and that AIDS in such advance condition is a cruel disease, you have hope one day and the next you loss it, and the suffering is to strong. Keep on your fight against HIV/AIDS; you and your colleagues do a hell of a work, yet there is so much to be done, especially in countries like mine with a very poor social care. (ONUSIDA and other organizations are doing some work in prevention)

By, and receive all the good energy from the beautiful world we live on. My next meditation in yoga will be for you great people.

Al.

Response from Dr. Frascino

Hello Al,

I'm very sorry to learn about your relative's passing. I, too, am confident he has found a place of health, peace and contentment beyond what we mere mortals could ever even conceive of!

Regarding the chance of recovery once CD4 counts have fallen to close to zero, yes. In fact, there is a chance for significant and dramatic immune reconstitution. The real problem is that the lower the CD4 count falls, the more severe the degree of immune impairment (immune deficiency). When the immune system is deficient, we become susceptible to a wide variety of infections that generally wouldn't bother us, because our immune system would contain or cure them. These infections are called opportunistic infections. They take the "opportunity" of the immune system being deficient to cause all sorts of problems. Generally speaking, we don't succumb to HIV, but rather to the opportunistic infections that occur as a result of HIV-induced immune damage. Some HIV-positive folks have had CD4 counts as low as your relatives, but managed, by luck and by taking prophylactic medications, to avoid opportunistic infections long enough to allow their antiretroviral medications enough time to decrease HIV replication and subsequently allow CD4 counts to improve. As the CD4 counts go up, the risk of OIs decreases. Generally speaking, counts that go up and stay above 200 significantly reduce the frequency and severity of opportunistic illnesses.

Unfortunately your relative was hit with several opportunistic illnesses before he had the chance to improve his immune status. Once again, I'm sorry for your loss.

Dr. Bob



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