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.

We just brought home a foster cat named Sunshine. He’s an unbelievable lovebug who wants to be close to us at all times — he just won’t stop purring and nudging for love!

Sadly, Sunshine is FIV-positive, which is why we’re hesitant to follow through with adoption. We recently lost a cat to lymphosarcoma, and it’s still hard on both of us. We want to be sure to give him the best possible care to be certain he’ll stay healthy.

We’ll probably pay a visit to the vet sooner or later, but I’m trying to keep his stress levels low as he adjusts to his new home (he seems to love it; he’s cuddling next to me on his back right now). Do you have any recommendations about how to give him the best of everything? And are his chances of living a long, healthy life good?

Many thanks!

~Sunshine, Alicia, and Tony

Siouxsie: First of all, thank you for taking in a foster cat. And thank you even more for being willing to open your home and your heart to an FIV-positive cat. All cats deserve loving “forever homes,” and we think humans who take in cats with special needs are particularly wonderful.

Thomas: Cats infected with the feline immunodeficiency virus can live long, healthy lives as long as they get the best possible care. It sounds to us like you’re willing to do all you can to keep Sunshine healthy.

Dahlia: You didn’t mention how old Sunshine is, but if he’s still fairly young (less than six months), he should be retested again after he’s reached that age. Sometimes kittens get FIV antibodies from their mothers while nursing, and this can lead to a false positive result.

Siouxsie: Any cat that comes up positive for FIV on the standard ELISA test–the quick test usually used in vets’ offices and shelters–should be re-tested with another diagnostic test called the IFA or Western Blot to confirm the diagnosis. This test costs more and it takes a week or so for the results to come back, but it’s a good idea to have the diagnosis confirmed with a more accurate test.

Thomas: Cats that have been vaccinated against FIV also come up positive when given an FIV test. This is one reason why the FIV vaccination is not recommended for most cats. The vaccine will not help to prevent FIV infection in cats that are already infected, either.

Dahlia: There are a lot of things you can do to help Sunshine stay as healthy. The most important thing, by far, is to keep him inside. As an indoor cat, he won’t be exposed to infections from other cats. You’ll also prevent Sunshine from infecting other cats.

Siouxsie: Vets have found that FIV is transmitted almost exclusively through bite wounds, which is one reason why FIV is usually found in un-neutered male cats. Tomcats fight for territory and mating rights, and in the course of these fights, biting often occurs. Mating and casual contact like snuggling doesn’t spread FIV. And while we’re on the subject of disease transmission, cats can’t give humans FIV, either.

Thomas: FIV has three stages. The first is the acute stage, which happens 4 to 6 weeks after being exposed. The acute stage usually manifests as fever, swollen lymph nodes, and a susceptibility to skin or intestinal infections.

Dahlia: The second stage is called the latent stage, where there are no signs of disease. This stage can last for many years, although during that time the immune system is gradually being destroyed. When the immunodeficiency becomes severe, the cat enters the final, or AIDS-like stage.

Siouxsie: The final stage brings a great increase in susceptibility to bacterial, fungal, or viral infections. In a healthy cat, these infections wouldn’t cause problems. However, in an FIV-positive cat, they can result in chronic respiratory infections, repeated oral infections, chronic diarrhea, and so on.

Thomas: Vets say an FIV-positive cat can live up to 12 years if he’s well taken care of. But there are stories of FIV-positive cats living 20 years or more with no symptoms of any severe disease. Kris Littrell of Best Friends Animal Sanctuary wrote a wonderful article called “FIV: Catching a Bad Case of Rumors,” which you may want to read in order to reassure yourselves that Sunshine can have a wonderful, long life, FIV-positive or not.

Dahlia: So what can you do to keep Sunshine as healthy as possible? First of all, as we said earlier, keep him indoors.

Siouxsie: Keep his stress level as low as possible by minimizing traumatic changes in his life. For example, if you have to go away on vacation, it would probably be better to keep Sunshine at home and have a family member or familiar cat-sitter take care of him rather than putting him in a boarding facility. (Most boarding facilities won’t take FIV-positive cats anyway.)

Thomas: Feed Sunshine an extra high-quality food. The better his nutrition and the fewer chemical preservatives and irritating additives he gets, the better he’ll be able to maintain his immune function as long as possible. However, do not feed him a raw food diet, no matter what anyone tries to tell you about the health benefits and so on. Uncooked foods, meats especially, can have parasites and pathogens that a cat with a normal immune system might be able to handle but an FIV-positive cat might not.

Dahlia: Discuss vaccination schedules with your vet. There are a few vets who say that FIV-positive cats shouldn’t be vaccinated at all, but you really need to talk about this with your vet and trust what he or she says on the subject. Most vets these days use a very conservative vaccination schedule anyway, typically only vaccinating against rabies (which is required by law in many parts of the US) and feline respiratory infections.

Siouxsie: If Sunshine develops even the slightest sign of an infection, he should go to the vet. Because his immune system is compromised, infections will need earlier and more aggressive treatment than they would in FIV-negative cats.

Thomas: Parasite control is also very important. You want to make sure that Sunshine isn’t exposed to fleas and doesn’t get worms. If he does get worms, he should be treated immediately. Parasites can cause a host of problems in immunocompromised cats, and fleas tend to infect weaker animals first.

Dahlia: There is currently no effective treatment for FIV infection. However, attempts to find a cure for AIDS in humans involves FIV in cats as a research model. As this research progresses, there may be a treatment for FIV.

Siouxsie: You might consider working with a holistic veterinarian as well as your regular vet. Holistic vets generally can offer good advice on nutrition, and perhaps on complementary health care such as homeopathy that can be of assistance in keeping the “whole cat” as healthy as possible. You can find a directory of holistic vets in the US and Canada at the American Holistic Veterinary Medical Association website.

Thomas: Here are some other resources you might find helpful: FIV in cats: Not an automatic death sentence (about.com cats forum); Owning an FIV-positive cat (marvistavet.com); and the FIVCats group at yahoo.com (a discussion group for caretakers with cats who are living with FIV).

Dahlia: Thank you again for caring so much about Sunshine. We know FIV can be a tough diagnosis to hear, but with your love and care, Sunshine will be able to live a happy and healthy life — for however many years that might be.