Dear Most Esteemed and Knowledgeable Kitties:

I am disabled and a Vietnam veteran and my cat, my best and only friend, has FIV and stomatitis. One vet says he can be helped and one vet says to put him to sleep. Can anyone help me keep my friend with me?

~J

Siouxsie: First of all, J, we want to say we know how hard it is to face losing your friend to this chronic and progressive disease. Mama’s first cat companion had FIV, so she has tremendous compassion for what you’re experiencing.

Thomas: Because of the stomatitis diagnosis, it sounds like your cat is in the third stage of FIV infection.

Dahlia: FIV infection has three stages. The first stage happens shortly after the cat is infected. Sometimes this stage has no symptoms, but some cats develop a fever and other signs of acute illness.

Siouxsie: In the second stage of the disease, the cat has no symptoms at all. This stage can last for many years.

Thomas: In the third stage, an FIV-positive cat’s immune system weakens considerably and he becomes highly susceptible to opportunistic bacterial, viral, or fungal infections.  These infections may improve with a round of antibiotics but then resurface when the antibiotics are discontinued.

Dahlia: Stomatitis, infection and  inflammation of the mucous membranes in the mouth, is a very common condition in third-stage FIV-positive cats.

Siouxsie: Although it is possible to manage FIV, there is, as yet, no cure for the illness.

Thomas: The American Association of Feline Practitioners’ (AAFP) 2008 guidelines for management of retrovirus infections (FIV and Feline Leukemia) publication lays out a few options. It’s written in “doctor-ese,” of course, but here are a few things we pulled out and translated into English.

Dahlia: Some drugs that have been used to treat AIDS in humans have improved immune system function in FIV-positive cats. AZT is one of these, but it tends to have some serious toxic side effects in cats. Alpha-interferon (natural human interferon alpha) has improved survival rates in FIV-positive cats, too, because it stimulates the production of certain types of immune system cells and doesn’t seem to cause as many harmful side effects as AZT.

Siouxsie: Most treatment for FIV-positive cats revolves around managing the opportunistic infections that arise as a result of the cat’s compromised immune system — antibiotic and antifungal medications, for example.

Thomas: The AAFP guidelines recommend avoiding steroid treatment because these drugs can further weaken the immune system. For cats with stomatitis, for example, they recommend removal of all the teeth rather than continuous use of steroids to reduce the swelling.

Dahlia: Griseofulvin, a systematic antifungal drug, is also not recommended for use in FIV-positive cats because it destroys neutrophils. Neutrophils are a type of white blood cell, and since white blood cells are the primary line of defense in the immune system, you don’t want to mess with those.

Siouxsie: Another thing you’ll need to watch very carefully, J, is your cat’s appetite. Cats in third-stage FIV often start to lose their appetites or have gastrointestinal symptoms like diarrhea, and your cat needs his food and fluids to stay as healthy as possible.

Thomas: Some people have added Omega-3 and Omega-6 fatty acids and vitamin supplements to their FIV-positive cats’ diets. There has been little scientific research on the effectiveness of vitamin and fatty acid supplements, but anecdotal evidence suggests that using such supplements with your vet’s guidance is not going to do any harm.

Dahlia: We’re very sad to tell you this, but we think it’s important for you to know. Most of the materials we’ve read (and Mama’s experience with her own FIV-positive cat)  indicate that most cats in the third stage of FIV don’t live much longer than a year, even with treatment.

Siouxsie: So, J, there are treatments that can help your cat to live longer. They may be quite costly, so you need to be prepared for that. But there’s no reason why even third-stage FIV needs to be an immediate death sentence.

Thomas: All this does, of course, depend on your cat’s current state of health and the strength of his immune system. We recommend you go with the “it’s possible to manage this illness” attitude, but be prepared for the financial and emotional cost.

Dahlia: You’ll still need to be vigilant and observe your cat with a loving — if breaking — heart and allow him the mercy of letting him go when he’s ready. As long as you’re able to be honest with yourself about whether or not your cat has a decent quality of life and observe with your heart, you’ll know when he’s tired of fighting.

Siouxsie: In the meantime, enjoy each day with your cat friend, and be present with him. Although your friend’s passing is inevitable, and it would be even if he didn’t have FIV, please try not to worry about when that day will come.

Thomas: Some people try to cope with an impending loss by shutting down their hearts. Try not to emotionally distance yourself from your cat because he needs your love now more than ever. Allow yourself to relish his company and give yourself the opportunity to come to terms with the loss.

Dahlia: There are online support groups for caretakers of FIV-positive cats. One forum we found was the Yahoo Group FIVCats. Joining such a group may help you feel less alone in your quest to give your cat the best possible quality of life. These groups often have forums and lists of resources for coping with grief and loss, too.

Siouxsie: We wish you and your cat the best of luck, J.