Case 4 :  

Two years later, after receiving several trials of antiretroviral medications, the patient has shown steady deterioration with 30 lb weight loss, fevers, sweats, visual loss, and marked enlargement of his lymph nodes.    He is debilitated and expresses profound depression.    He is diagnosed with CMV retinitis, and lymph node biopsy reveals non-Hodgkin lymphoma.   His CD4 count = 10 / mm 3.      He elects not to receive further therapy, and asks for hospice placement.