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Jun 10, 2007

God Bless you Dr. Franscino for taking time to answer our questions! My brother who evidently has been either living in denial or stupidly not been tested is now in Critical Care Unit with diagnosis of PCP, MRSA and CMV. The doctor hinted to me that my brother would HAVE to be in full-blown AIDS to have PCP & CMV and that there is no way he'd these if he was recently HIV+ -- that it had to be full blown AIDS. My brother is on a ventilator w/trach, is diabetic on top of it all and has shown no improvement despite antivirals, Vancomycin and other broad-spectrum anti-biotics. My research indicates a 90% mortality rate. What is your opinion - and do NOT sugar-coat it, I really want to know his odds of pulling out of this. I will not give up hope or prayers, but I do want your opinion. Thank you so much. I wish you continued great health.

Response from Dr. Frascino


I'm sorry to learn of your brother's current medical challenges.

My opinions are always honest and never sugarcoated. Your brother has AIDS based on his diagnosis of PCP (Pneumocystis carinii pneumonia) and CMV (cytomegalovirus). Most likely his CD4 count is well below 200, which would be yet another condition confirming the AIDS diagnosis (as opposed to just being HIV-positive). I don't particularly like the "full blown AIDS" terminology, because there is no such thing as "partially blown AIDS." A person infected with the virus is either HIV positive or has AIDS based on the presence or history of specific opportunistic infections or a CD4 count of less than 200.

There is no doubt your brother is critically ill in that he requires assisted ventilation and intensive care support and has complicating conditions, including diabetes and MRSA (methicillin-resistant staphylococcus aureus). That he is not responding to vancomycin, broad-spectrum antibiotics and antiviral drugs is a poor prognostic sign. Without knowing additional information, such as CD4 count and viral load and the severity of his PCP, CMV and MRSA, etc., I cannot give you a mortality risk statistic other than to say his prognosis at this point is poor. However, that said I too would definitely not abandon hope, as I've seen some very dramatic recoveries that would rival Lazarus returning from the dead!

Finally, I agree your brother's HIV disease is not recent. However, whether or not he realized he was HIV positive is another issue entirely. I have seen many folks present with an opportunistic infection indicating late-stage AIDS who never even considered themselves at risk for acquiring the virus.

Please give your brother a hug from me and support him with love and kindness.

My heart goes out to you both.

Dr. Bob

Paranoid or what!
Coffe with Kurt from Palo Alto

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