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Abstract

Background: Palliative care is extremely important for human immunodeficiency virus (HIV)-infected clientele. The impact of HIV infection is significant in the city of New Orleans. As of September 2009, a cumulative total of 29 548 HIV/acquired immunodeficiency syndrome (AIDS) cases and 12 267 HIV-related deaths were reported in Louisiana. Methods: Retrospective review of charts of patients enrolled in our palliative care program. Results: As of September 2009, there were around 1800 active patients in our HIV outpatient clinic. A total of 5 (22%) patients had multidrug-resistant AIDS infection. Three (13%) referred patients had AIDS dementia. Progressive multifocal leukoencephalopathy (PML) and advanced HIV nephropathy were also reasons for referral (13% and 4% of referred patients, respectively). Around 9% of patients had advanced liver cancer with metastases. In all, 22% of patients had rapidly deteriorating functional status. The rest of the patients (26%) complained of cancer-related nausea and vomiting and progressive and nonresponsive weight loss. In terms of psychosocial assessment, the majority of referred patients had problems in areas such as social functioning, mood swings, unstable moods, problems with controlling temper, outbursts of anger, violence, and disturbing or unreal thoughts and beliefs. Conclusions: Palliative care is extremely important in the care of patients with HIV/AIDS. More research is needed to elaborate on best palliative care practices in the care of HIV-infected patients. Interesting to note is that there is significant proportion of patients with mental issues (substance abuse, psychiatric problems, depression, and despair) for which better resources are needed. Integration of services among clinical, mental, and palliative care providers might be needed to better serve this population.

Keywords

palliative care HIV/AIDS mental problems

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References

Brunnhuber K. , Nash S. , Meier DE , Weissman DE , Woodcock J. Putting evidence into practice: palliative care. Br Med J. 2008: 1-88.

Louisiana Department of Health and Hospitals Office of Public Health HIV/AIDS surveillance. Louisiana HIV/AIDS Surveillance Quarterly Report. 2009;7(3):1-2.

Kell ME , Walley JD Palliative care for HIV in the era of antiretroviral therapy availability: perspectives of nurses in Lesotho. BMC Palliat Care. 2009;8:11.

Krug R. , Karus D. , Selwyn PA , Raveis VH. Late-stage HIV/AIDS patients’ and their familial caregivers’ agreement on the palliative care outcome scale. J Pain Symptom Manage. 2010;39(1):23-32.

Wantland DJ , Holzemer WL , Moezzi S. , et al. A randomized, controlled trial testing the efficacy of an HIV/AIDS symptom management manual. J Pain Symptom Manage. 2008;36(3):235-246.

Jameson C. The role of a palliative care inpatient unit in disease management of cancer and HIV patients. S Afr Med J. 2007;97(9): 849-852.

Harding R. , Easterbrook P. , Higginson I. , Karus D. , Raveis V. Access and equity in HIV/AIDS palliative care: a review of the evidence and responses. Palliat Med. 2005;19(3):251-258.

Lorenz KA , Cunningham WE , Spritzer KL , Hays RD Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV. Qual Life Res. 2006;15(6):951-958.

Robinson L. , Dugger K. , Fong G. , et al. Palliative home nursing interventions for people with HIV/AIDS: a pilot study. J Assoc Nurses AIDS Care. 2006 ;17(3):37-46.

10.

La Fosse H. , Schwartz CE , Caraballo RJ , Goeren W. , Selwyn PA Community outreach to patients with AIDS at the end of life in the inner city: reflections from the trenches. Palliat Support Care. 2004;2(3):305-314.

11.

Lorenz KA , Hays RD , Shapiro MF , Cleary PD , Asch SM , Wenger NS Religiousness and spirituality among HIV-infected Americans. J Palliat Med. 2005;8(4):774-781.

12.

Bennett M. , Spillet M. , Kutzen H. Evaluation: HIV clinic’s palliative care is a success. HIV Clin. 2005;17(3):8-10.

13.

Harding R. , Easterbrook P. , Dinat N. , Higginson IJ Pain and symptom control in HIV disease: under-researched and poorly managed . Clin Infect Dis. 2005;40(3):491-492.

14.

Harding R. , Gwyther L. , Powell FM. Treating HIV/AIDS patients until the end of life. J Acquir Immune Defic Syndr. 2007;44(3): 364.

15.

Selwyn PA , Rivard M. , Kappell D. , et al. Palliative care for AIDS at a large urban teaching hospital: program description and preliminary outcomes. J Palliat Med . 2003;6(3):461-474.

16.

Selwyn PA Palliative for patient with human immunodeficiency virus/acquired immunodeficiency syndrome. J Palliat Care. 2005;8(6):1248-1268.

17.

Arnold RM , Liao S. The challenge of human immunodeficiency virus: a model for palliative care . J Palliat Med. 2005;8(6): 1246-1247.

18.

Selwyn PA , Forstein M. Overcoming the false dichotomy of curative vs. palliative care for late-stage HIV/AIDS: ‘‘Let me live the way I want to live, until I can’t .’’ JAMA. 2003;290(6):806-814.

19.

Karus D. , Raveis VH , Alexander C. , et al. Patient reports of symptoms and their treatment at three palliative care projects servicing individuals with HIV/AIDS. J Pain Symptom Manage. 2005;30(5):408-417.

20.

Podymow T. , Turnbull J. , Coyle D. Shelter-based palliative care for the homeless terminally ill. Palliat Med. 2006;20(2):81-86.

Palliative Care Program For Human Immunodeficiency Virus-Infected Patients: Rebuilding of an Academic Urban Program

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