There are no guidelines regarding the discontinuation of antiretroviral therapy at the end of life.
Methods:
We retrospectively reviewed our databases and identified patients with HIV/AIDS who died over the last 12 months in our HIV clinic.
Results:
A total of 41 patients from our HIV clinic died in a period of 12 months. Seventy-three percent of the patients were on antiretroviral therapy during the last clinic visit. During the last 3 months of life, 32% (13 of 41) were off antiretroviral therapy, with 77% (10 of 13) of them having intermittent therapy due to noncompliance. The remaining 23% (3 of 13) decided to stop antiretroviral therapy after discussion among families, patients, and providers.
Conclusion:
Discussions among providers, patients, and families are encouraged to establish goals of care and role of antiretrovirals during the last months of life.
StewartAChan CarusoneSToKSchaefer-McDanielNHalmanMGrimesR. Causes of death in HIV patients and the evolution of an AIDS hospice: 1988-2008[published online May 17, 2012]. AIDS Res Treat. 2012.
2.
HorbergMAAbergJACheeverLWRennerPO'Brien KalebaEAschSM. Development of national and multiagency HIV care quality measures. Clin Infect Dis. 2010;51(6):732–738.
3.
FarrantLGwytherLDinatNMmolediKHattaNHardingR. The prevalence and burden of pain and other symptoms among South Africans attending highly active antiretroviral therapy (HAART) clinics. S Afr Med J. 2012;102(6):499–500.
4.
Centers for Disease Control and Prevention. Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2008. Atlanta, GA: Centers for Disease Control and Prevention; 2010.
Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-Infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50(10):1387–1396.
7.
SimmsVHigginsonIHardingR. Integration of Palliative care throughout HIV disease. Lancet Infect Dis. 2012;12(7):571–575.
8.
American Academy of Hospice and Palliative Medicine. UNIPAC Series. Volume I. Glenview, IL: American Academy of Hospice and Palliative Medicine; 2010.
9.
FaustoJASelwynPA. Palliative care in the management of advanced HIV/AIDS. Prim Care. 2011;38(2):311–326. doi: 10.1016/j.pop.2011.03.010.
10.
SelwynP. Palliative care for patient with human immunodeficiency virus/acquired immune deficiency syndrome. J Palliat Med. 2005;8(6):1248–1268.
Cruz-JentoftAJBolandBRexachL. Drug therapy optimization at the end of life. Drugs Aging. 2012;29(6):511–521. doi: 10.2165/11631740-000000000-00000.
13.
ParsonsCHughesCMPassmoreAPLapaneKL. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying?Drugs Aging. 2010;27(6):435–449. doi: 10.2165/11536760-000000000-00000.
14.
LeeSPBainKTMaioV. Apropriate discontinuation of medications at the end of life: a need to establish consensus criteria. Am J Med Qual. 2007;22(6):393–394.
15.
MartinssonLFürstCJLundströmSNathanaelssonLAxelssonB. Registration in a quality register: a method to improve end-of-life care--a cross-sectional study. BMJ Open. 2012;2(4). doi: pii: e001328. 10.1136/bmjopen-2012-001328.
16.
RaijmakersNJvan ZuylenLFurstCJ. Variation in medication use in cancer patients at the end of life: a cross-sectional analysis. Support Care Cancer. 2013;21(4):1003–1011.
17.
McLeanSSheehy-SkeffingtonBO'LearyNO'GormanA. Pharmacological management of co-morbid conditions at the end of life: is less more?Ir J Med Sci. 2013;182(1):107–112.
18.
FrechenSZoellerARubergKVoltzRGaertnerJ. Drug interactions in dying patients: a retrospective analysis of hospice inpatients in Germany. Drug Saf. 2012;35(9):745–758. doi: 10.2165/11631280-000000000-00000.
19.
FinckeBGMillerDRSpiroA. The interaction of patient perception of overmedication with drug compliance and side effects. J Gen Inter Med. 1998;13(3):182–185.
20.
KrugRKarusDSelwynPARaveisVH. 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.
21.
AhdiehGLSilverbergMJPalacioH. Discontinuation of potent antiretroviral therapy: predictive value of and impact on CD4 cell counts and HIV RNA levels. AIDS. 2001;15(16):2101–2108.
22.
SimpsonDHaidichABSchifittoG. Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels. AIDS. 2002;16(3):407–412.
23.
MurphyELCollierACKalishLA. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Inter Med. 2001;135(1):17–26.
24.
WilligJHWestfallAMugaveroMJ. Effect of persistency of first-line HIV antiretroviral therapy on clinical outcomes. AIDS Res Hum Retroviruses. 2013;29(4):698–703.
25.
GeboKAFleishmanJAConviserR; HIV Research Network. Contemporary costs of HIV healthcare in the HAART era. AIDS. 2010;24(17):2705–2715. doi: 10.1097/QAD.0b013e32833f3c14.
