HIV & The Will (or its absence) to Live

Although I primarily practice infectious diseases and critical care medicine, I am also trained and board-certified in emergency medicine. To keep somewhat active in the field, I work about one shift per month in an emergency department (ED). I don't often have my infectious disease world intrude into the ED, but yesterday it did. 

I was involved in the care of a AIDS patient with toxoplasmosis who came to the ED for an unrelated reason. However, the infectious disease issue soon supplanted the original reason for the visit. 

Toxoplasmosis occurs in AIDS patients who are severely immunosuppressed. This opportunistic infection, which is treatable, was much more common in earlier eras in which individuals with HIV had no effective treatments. In the modern era, in those who have access to medications, it is quite rare. In my ID fellowship, I think I only saw one case in an individual newly diagnosed with HIV. 

Yesterday's case wasn't like that--this person had willfully stopped taking anti-retrovirals and anti-toxoplasmosis medications. 

I found the entire experience frustrating as I, like many other physicians before me, was futile in  persuading the patient that without treatment death would soon occur. 

As I've learned by myriad interactions with individuals recalcitrant to complying with treatment recommendations, a fundamental choice to live has to be the precondition for anything anyone says to matter.