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what now...
May 29, 2006

Hello My brother was admitted into the hospital with pneumonia. Turned out to be PCP and he was diagnosed with HIV/AIDS. His CD4+ count is very low (not sure of exact number). He is being treated for other infections as well. If he recovers from these, what is his next step once released from hospital. With such a low CD4+ count what meds are best is his condition to help strengthen his immune system and fight the HIV virus. We believe he was in denial of being HIV+ and never treated it in the past . This all caught our family off gaurd. Please, any info you can give would be much appreciated...

Response from Dr. Daar

The good news is that there are may HIV treatment options currently available for your brother. In fact, we often meet people presenting with advanced immunosuppression and PCP who then come to clinic, start antiretroviral medications and do unbelievably well. Many of these people I anticipate living a normal life on treatment.

The large number of treatment options currently available creates a situation where we individualize therapy for each patient. The next step for your brother is to get connected with an HIV specialist that he trusts and can work with. As he recovers from his PCP discussion can ensue regarding the many treatment options. Once he is ready to start a select regimen it will be initiated with close follow-up for side effects and response. If side effects occur they can be managed and/or therapy modified until the medications are well tolerated. Similarly, if response to therapy such as increase in CD4 cells and decline in viral load is suboptimal treatment can be adjusted until the goal of undetectable levels of virus is achieved. In most people it is smooth sailing after that and the disease is often controlled, possibly for many years if not for life.

One can not minimize the emotional and psychological impact this diagnosis has on people. This is where family and friends can play an enormous role in supporting a person as they work through this difficult time. Based upon your post it sounds like your brother has this kind of support already in place. With all of you and a good HIV provider he should do great!! Best, Eric

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