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

Answer: Simon Collins

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.

questions@i-Base.org.uk

Simon