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Final stage
Nov 29, 1996

My brother Alfonso has 10 CD4, he is in the final stage of AIDS. He doesnt look well but the doctor say he is stable. He got PCP, Candida an some infection in his stomach. All of these thing are under control with a lot of medications I cant find any information about the final stage and what can i do. My doctor said : Dont try anything else, you just have to wait his dead but still with AZT and DDI, everything you tried to do maybe is going him to suffer more. What do you think ? Can i tried something else ? He is almost all the time sleeping. What about the persons in this stages, What about his brain and psycologycal problems ? Cand you tell us all about the final stage? He is going to die because PCP ? My doctor said: in many cases the hearth stops Is this right? Thanks

Response from Dr. Cohen

I'm afraid that it's hard for me to give you much specific information or advice that will help you or your brother. There does come a time when the most important thing you can for someone is to keep them as comfortable as possible, to take away their pain and their anxiety, and to be with them. At that point, trying to aggressively treat their HIV disease or its complications may be futile and may only add to their misery.

Because I don't know him, I can't say whether your brother has reached that point yet. We know that even people with very low CD4 counts and advanced disease can sometimes have dramatic responses to aggressive antiretroviral therapy with protease inhibitors. However, those therapies can be complicated and can have a lot of side effects, especially in patients who are very sick. Some people are simply too sick to either tolerate the therapy or to get much benefit from it.

I can't tell you how your brother will die. Yes, the heart stops, but that is not usually the cause of death, simply the result. People can die of PCP, but there are many other complications that can lead to death. As for his brain, all I can say is that while some people develop brain dysfunction (dementia, for example) at advanced stages, not everyone does.

If you feel that that it's too early to be giving up and that your brother may benefit from more therapy than his doctor wants to give, you might look for a second opinion. I have found that doctors who are not experienced with HIV infection sometimes assume that things are irreversible long before they actually are. But his doctor may also be right.

Finally, it's important to know how Alonso feels about this, if he's able to tell you. Does he still want aggressive treatment, or is he ready to focus more on being comfortable and improving the quality of the end of his life?



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