Many speculated that he had liver failure or that he had an acute cholecystitis, cholangitis with sepsis after a botched ERCP, etc..As to the liver failure part, he didn't really have much stigmata of end stage liver disease...not particularly jaundiced, no ascites. We can only speculate because of the thrombocytopenia. As to the cerebral hemorrhage, could he have had ring enhancing lesions from toxoplasmosis or cryptococcus and the French made the wrong diagnosis? Who knows!
As to HIV being rampant in the US, it certainly is a huge problem in large cities. I've worked at Grady in Atlanta, and hospitals in New Orleans, and Chicago...and took care of too many HIV patients. I'm now settled in the Panhandle of Florida and just 2 months ago was consulted on a patient that came through the ER. He was an emaciated 24 y/o guy with shortness of breath, chest pain, hypotension and massive cardiomegally on CXR. Lab wise, he was pancytopenic. To make the story short, he had cardiac tamponade. As it was 3AM when I saw this guy, I performed an ultrasound guided pericardialcentesis and floated a triple lumen catheter/central line into the pericardial sac. Pulled out 850cc of pericardial fluid. Guess what, it was acid-fast positive! This dude had TB. He was eventually found to be HIV positive as well with high viral load. He eventually got a pericardial window and discharged 2 weeks later.
I've worked on Indian reservatoins and seen lots of TB. And in Africa, it was a common diagnosis for FUO...now it is coming back, and those with HIV never get cured...it's a disaster in the works, but little publicity.
Imagine if we started forcing hospitalization for months like they did in the past for TB...yet that is what they have to do...guess we'll have to wait till a big epidemic in a jail occurs...