New HIV/AIDS diagnoses, pneumonia (PCP), please help!

Question

We've heard so many different things so far with the entire host of medical staff in the hospital, primary doctor with no real knowledge of AIDS, and only speaking with social worker otherwise: Brief Hx: Admitted to hospital Nov 1 with severe lung infection and reactive airway. Nov 2 officially diagnosed with pneumonia and prescreen positive for HIV. Diagnosed Nov 5, 2010 through positive Western Blot, CD4, and VL with AIDS - CD4 of 45 (6%) and VL 659,000. Male age 38, height 5 feet 6 inches, current weight 181 pounds. Previous weight one year ago 275 pounds. Weight disappeared within 2 months last year and has been maintained around 180 pounds since. Dropped to 174 pounds in hospital but has regained to 181 in 3 weeks. Was unaware of HIV/AIDS prior to Nov 5, 2010. Discharged from hospital Nov 8 with a LOT of medications (antibiotics, steroids, anxiety meds, breathing treatments, and 24/7 oxygen at 3 to 4 liters - now only weaned down to 2 liters three weeks later and not needing it constantly, but frequently). Nov 15 we were informed pneumonia is PCP and have not been told culture sensitivites. Nov 22 intake appointment with case manager at AIDS clinic and set up appointment for DEC 13 for lab studies and possible genotyping. Nov 29 repeat chest x-ray and doc said it looks no different than Nov 1 x-ray, although O2 saturation is better (beginning low 71% on room air now 95% on room air). Current meds Bactrim 2 pills 3 times a day (every 8 hours), azithromycin 250 mg once a day for 10 days. Just completed 3 week course of prednisone. One multivitamin daily. Xanax 0.25 mg once every evening. Coughing frequently but it is not frequently productive. It's productive once or twice a day. (He's wondering if he can take an expectorant like Mucinex)?

I have a couple questions: First, they've said we need to work on getting his immune system built up by taking vitamins, eating a good balanced diet, etc. We won't start treatment until January 2011 or shortly thereafter we're assuming so is it possible to boost or maintain CD4 count in the meantime? Also, if it is possible to boost CD4, will that not affect the viral load? Will it make it go up?

Second question: This pneumonia is not getting better but not getting worse. It's almost as if progress has plateaued and it's not budging either way. Is this normal for PCP with a low CD4 and high viral load without treatment for virus? Will the PCP ever really go away? He's taken rocephin, avelox, erythromycin, azithromycin, bactrim, diflucan, and albuterol with ipratropium (duoneb) all within this month and has had almost no response. The only improvement has been his appetite with the steroids and his room air saturations improved this week to 95% but no change on x-ray. I think our biggest concern at the moment is the pneumonia as we're well aware that pneumonia can be fatal in some situations. What can we do to get rid of it or help jump start healing? What can we do about immune system in the meantime while awaiting treatment? He's on prophylactic antibiotics as well as bactrim for PCP.

Answer

He needs HIV treatment immediately. I don't understand the delay until January. This is absolutely not acceptable. Vitamins are not the answer. Yes, there can be a recurrence or persistence in symptoms of PCP, particularly if the CD4 count is so suppressed, as his is now. More CD4 cells are the answer here, and that is not going to happen without HIV meds.