He's in Rockingham County, VA. We've never been convinced that he's gotten good medical care, but we are told that their doctors have consulted specialists in other areas.
If that was my brother I'd beg him to collect his medical records,hop in the car and head right for one of the teaching affiliates of either Georgetown or George Washington University Medical School in DC.
Having worked at one of the major Harvard teaching hospitals for 20+ years I can pretty much guarantee you that an ID specialist in DC sees 50 times more cases like your brother's than does the doctor currently treating him.
And if Duke is closer to him than DC,the same would go for one of the Duke teaching hospitals.