Question
My brother is sick with a CD4 of 2 – what can we do?
20 October 2024. Related: All topics, CD4 and viral load, Changing treatment, Complications and coinfections.
Hi my brothers has AIDS he was diagnosed in his last stages and ended up with meningitis.
He also had a 2 week drip now he is at home the doctors said his cd4 count is 2 so he is very ill
Only getting diarrhea and not able to keep food down only spewing and in the bed what would you say is this normal and what can we give him to boost his appetite.
Thank you
Answer
Hi there
Thank you for your email.
i-Base are not doctors but there is lots of information that can help your brother,
First, he needs good doctors that have experience of very advanced HIV.
You don’t say which country you are in, but if your doctor doesn’t have this experience they need to talk to doctors who do – probably at the nearest large city hospital.
If your brother was only recently diagnosed with a very low CD4 count, he is unlikely to have drug resistance. This means that starting effective treatment now has a good chance of helping recover good health again.
The reason that the doctor needs good experience is that his symptoms could be caused but several different complications. Some, such as TB, might need to be treated first. Most though can be treated at the same time as HIV treatment.
The sooner your brother starts HIV treatment, the sooner he can get better. HIV meds – called ART – start working with the very first pill. The amount of HIV will dramatically drop even in the first few days, steadily dropping further over the next few weeks.
The doctor also needs experience because the very low CD4 count might cause new complications called IRIS in the first few months of HIV treatment.
If your brother has already been on treatment and his viral load is still very high, he might already have drug resistance. In this case the doctors need to change to a new combination.
Viral load is the blood test that say how much HIV is in a small sample of blood. Once on treatment this should become as low as possible, ideally to become undetectable.
Your brother also needs to be given a two-drug antibiotic called cotrimoxazole. This will protect him from several infections until his CD4 count gets much higher. The doctor should also check his eyes in case there are signs of CMV.
His symptoms of diarrhoea and being sick could be caused be several different conditions. Sometimes these can just become easier as his immune system becomes stronger on effective ART.
If your brother has white patches in his mouth this could be Candida (thrush). If this is also in his throat it makes it difficult to eat and hold food down. The doctor can easily check for this and prescribed an antifungal drug that might help. Otherwise, very simple soft or liquid foods can help.
Diarrhoea can be cause by bacterial infections in the stomach. The antibiotics might help, but getting a higher CD4 count can stop this best. If the diarrhoea is severe, please try to keep your brother hydrated by drink water, perhaps with some sugar for energy. Special medical drinks that are high in calories and supplements can also sometimes help. These can also be given by a pump through a small tube in the nose.
Everything else needs specialist advice from a team – working a day at a time until your brother can slowly get stronger again. This includes overcoming any problems like IRIS if they occur.
I am sorry for such a long answer, but please email me directly if this would help, especially if you have more details about other test results and about your brothers treatment.
Simon
Dear Blaise, thank you for sharing your experience. It is really god to hear you are doing so well. Thank you too for your kind feedback. Simon.
Very similar situation with me.
I was diagnosed with HIV a year ago with a cd4 count of 2, had meningitis, severe diarrhoea, low appetite, hospitalised twice for a week each time, lost a lot of weight. Have been on ARVs religiously since, achieved U=U during the first two months of treatment, regained 9 kilo, looking and feeling amazing everyday.
Thank you Team for your amazing work and serving my life.
No one should die of aids when taking ARVs as advised by your healthcare personnel.
I’ve never felt this great my whole entire life and I’m 44 years old.
Hi Trx, please do not worry about being linked to these symptoms. You are doing really well on your ART and keeping a viral load this low (ie anything less than 200) means your meds also protect your partner too.
This has been know for many years now and is also called U=U:
https://i-base.info/u-equals-u/
If your partner is HIV positive, it it likely to be from before you met each other, but weight loss can be casued my many other things too.
Your boyfriend is lucky that you are worried about him and so please encourage him to see a doctor. This is the only way to find out what is wrong.
Hi my boyfriend used to sweat on his legs and he has been losing weight. Are these symptoms of hiv becuz I’m hiv positive. My viral load has been 30 since I met him 4 yrs ago I’m scared that maybe I gave him HIV.
Hi Anonym, thanks for your feedback. Luckily most people are diagnosed early but people are still diagnosed late in every country. Even with a CD4 count this low I have known lots of people who have recovered to full health. I was also in the same situation many years ago and so the answer was from personal experience :)
This is sometimes difficult to read. Really hope the person and their bro are fine. Big thanks Simon for the answer, makes sense especially experienced doctors to work with persons with very low cd4 count as issues could be many.