Question

Hi there, My aunt has been sick for over a year (diarrhea, vomiting, flu-like symptoms), but we never thought that she was HIV+. She retired from her job in June 2007 and moved to Florida. Since then her condition has rapidly deteriorated and now she is in a Hospice with a Tcell count of 0.
Is there anything that we can do to build her cell count and get her started on some medications? The doctors said if she would only eat it would help, but it seems like she has developed a phobia where eating is concerned. Are there any next steps we can take? Please advise Thank you, Fighting for my aunt

Answer

I am sorry to hear that your aunt is so ill. It appears she has likely had unsuspected HIV infection for some time. The average time to develop AIDS after HIV infection is about 10 years. At this point the most important things to focus on are diagnosing and beginning treatment for any active opportunistic infections or HIV-related cancers that might be present. HAART therapy should also be started as soon as possible. Your aunt's body is producing CD4 (T cells) every day. The cells are being consumed by her infection (HIV lowers CD4 counts through a number of pathways). Suppression of HIV growth will give your aunt's body the chance to recover her immune system's balance.

It is very important for her to be well nourished during this process. Having food would make her medications more tolerable and provide the vitamins and nutrients her body will need during recovery. Appetite stimulants can be tried such as, Periactin, Marinol (especially if nausea is present), or Megace (but only for short-term use due to possible hormonal side effects). In some cases I have also used temporary feeding tubes (called a "PEG") which are placed in the stomach to allow feeds and medications to be given until the person is strong enough to take in sufficient calories by mouth. Also, if other medical conditions have been addressed, depression can lead to decreased appetite. Evaluation and treatment for depression may help.

I hope all goes well for your aunt, it is great that she has such a strong advocate on her side.

Best,

Joe