This article provides a clinically-oriented overview of palliative care for patients with AIDS. Indicators of decreased survival time are divided into categories of infections/illnesses, clinical signs and symptoms, immunological and serological markers, and psychosocial factors. Primary symptoms in AIDS are discussed according to etiology and treatment. However, treatments of opportunistic infections per se are not directly addressed in this article. Problems discussed include pain, confusion, depression and anxiety, fatigue, fever, dyspnea, nausea and vomiting, diarrhea, wasting, and dehydration. The article also briefly addresses clinical and ethical questions and challenges presented by AIDS to hospice or palliative care providers, and the various stages of HIV infection.
Get full access to this article
View all access options for this article.
References
1.
Amenta MO’R, Shubert V: (1994). Hospice nursing and the AIDS epidemic. Home Healthcare Nurse, 12(2): 54-55.
2.
Goldstone I, Kuhl D, Johnson A, Le R, and McLeod A: Patterns of care in advanced HIV disease in a tertiary treatment centre. AIDS Care1995;7(S1): s47-s56.
3.
National Commission on Acquired Immune Deficiency Syndrome: America living with AIDS. Washington, DC: Author, 1991.
4.
Stephany TM: AIDS does not fit the cancer model of hospice care. Am J Hosp and Pall Care1992;9(1), 13-14.
5.
Ungvarski PJ, Schmidt J: Community-based and long-term care. In: Flaskerud JH, Ungvarski PJ (eds.): HIV/AIDS: A guide to nursing care (3rd ed.). Philadelphia: W.B. Saunders Company, 1995: 339-363.
6.
Morrison C: Delivery systems for the care of persons with HIV infection and AIDS. Nsg Clinics of N Am1993;28(2), 317-332.
7.
Stansell JD, Follansbee SE: Management of late-stage AIDS. In: Sande MA, Volberding PA (eds.): The medical management of AIDS (4th ed.). Philadelphia: W.B. Saunders Company, 1995: 665-679.
8.
Clark RA, Blakely SA, Rice J, Brandon W: Predictors of HIV disease progression in women. J Acquired Immune Deficiency Syndromes and Human Retrovirology1995;9, 43-50.
9.
Justice AC, Feinstein AR, Wells CK (1989). A new prognostic staging system for the acquired immunodeficiency syndrome. New Eng J Med1989;320(21), 1388-1393.
10.
Welsby PD, Richardon AM: Palliative care aspects of adult acquired immune deficiency. In Doyle D, Hanks GWC, MacDonald N (eds.): Oxford textbook of palliative medicine. New York: Oxford University Press, 1993: 737-757.
11.
Zabay JM, Sempere JM, Benito JM, Gonzalez B, Obregon E, Diez J, Fernandez-Cruz E: Serum beta 2-microglobulin and prediction of progression to AIDS in HIV-infected injection drug users. J Pain and Symptom Manage1995;8(3), 266-272.
12.
Hoover DR, Rinaldo C, He Y, Phair J, Fahey J, Graham NMH: Long-term survival without clinical AIDS after CD4+ cell counts fall below 200x106/l. AIDS1995;9, 145-152.
Manaloto CR, Perrault JG, Carnigal LT, Santiago EG, Wignall FS, Gonzales VL, Anthony RL, Hayes CG: Natural history of HIV infection in Filipino female commercial sex-workers. J Acquired Immune Deficiency Syndromes1994;6(5), 1157-1168.
15.
Sttmann U, Ockenga J, Selberg O, Hoogestraat L, Deicher H, Mller MJ: Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquired Immune Deficiency Syndromes and Human Retrovirology1995;8, 239-246.
16.
Coodley GO, Loveless MO, Merrill TM: The HIV wasting syndrome: A review. Journal of Acquired Immune Deficiency Syndromes1994;7(7), 681-694.
17.
Morand-Joubert L, Costagliola D, Bludau H, Petit JC, Lefrre JJ: Predicting progression of HIV disease: Usefulness of acid-dissociated p24 antigen. J Acquired Immune Deficiency Syndromes1994;7, 676-680.
18.
Kemp CE: Terminal illness: A guide to nursing care. Philadelphia: J.B. Lippincott, 1995.
19.
Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson, J: Estimate of survival of patients admitted to a palliative care unit: A prospective study. J Pain Symptom Manage1992;7(2), 82-86.
20.
Martin JP: Issues in the current treatment of hospice patients with HIV disease. Hospice J1991;7(1-2): 31-40.
21.
Anand A, Carmosino L, Glatt AE: Evaluation of recalcitrant pain in HIV-infected hospitalized patients. J Acquired Immune Deficiency Syndromes1994;7(1), 52-56.
22.
Eldridge AD, Severance-Lossin L, Nicholas PK, Leuner JD’M: Prevalence and characteristics of pain in persons with terminal-stage AIDS. J Advanced Nsg1994;20, 260-268.
23.
Ungvarski PJ, Schmidt J: Nursing management of the adult client. In: Flaskerud JH, Ungvarski PJ (eds.): HIV/AIDS: A guide to nursing care (3rd ed.). Philadelphia: W.B. Saunders Company, 1995: 339-363.
24.
World Health Organization: Cancer Pain Relief and Palliative Care. Geneva: Author, 1986.
25.
McCaffery M, Beebe A: Pain: Clinical manual for nursing practice. St. Louis: C.V. Mosby, 1989.
Capaldini L: HIV disease: Psychosocial issues and psychiatric complications. In: Sande MA, Volberding PA (eds.): The medical management of AIDS (4th ed.). Philadelphia: W.B. Saunders Company, 1995: 289-317.
28.
Coyle N: Initial assessment and ongoing evaluation of cancer pain. Am J Hosp Pall Care1991;8(6), 27-35.
29.
Stillman MJ: Perineal pain: Diagnosis and management, with particular attention to perineal pain of cancer. In: Foley KM, Bonica JJ, Ventafridda V (eds.): Proceedings of the Second International Congress on Cancer Pain. New York: Raven Press, 1990: 359-377.
30.
Schug SA, Zech D, Drr U: Cancer pain management according to WHO analgesic guidelines. J Pain Symptom Manage1990;5(1), 27-32.
31.
Paice JA: Unraveling the mystery of pain. Oncology Nursing Forum1991;18(5), 843-849.
32.
Herr KA, Mobily PR: Interventions related to pain. Nursing Clin N America1992;27(2), 347-369.
33.
Chaisson RE, Volberding PA: Clinical manifestations of HIV infection. In: Mandel GL, Douglas RG, Bennett JE (eds.): Principles and practices of infectious diseases (3rd ed.). New York: Churchill Livingston, 1990: 1059-1092.
34.
Duggleby W, Lander J: Cognitive status and postoperative pain: Older adults. J Pain Symptom Manage1994, 9, 19-27.
35.
Novick DM: The medically ill substance abuser. In: Lowinson JH, Ruiz P, Millman RB (eds.): Substance Abuse: A Comprehensive Textbook (2nd ed.). Baltimore: Williams & Wilkins, 1992: 657-674.
Price RW, Brew BJ, Roke M: Central and peripheral nervous system complications of HIV-1 infection and AIDS. In: DeVita VT, Hellman S, Rosenberg SA (eds.): AIDS: Etiology, diagnosis, treatment, and prevention (3rd ed.). Philadelphia: J.B. Lippincott Company, 1992: 237-257.
38.
Price RW, Sidtis JJ: The AIDS dementia complex. In: Wormser GP (ed.): AIDS and other manifestations of HIV infection (2nd ed.). New York: Raven Press, 1992: 373-382.
39.
Worth JL, Savage CR, Baer L, Esty EK, Navia BA: Computer-based neuropsychological screening for AIDS dementia complex. AIDS1993;7(5), 677-681.
40.
Holland JC: Principles of psycho-oncology. In: Holland JF, Frei E, Bast RC, Kufe DW, Morton DL, and Weischselbaum RW (eds.): Cancer medicine (3rd ed.). Philadelphia: Lea & Feiberger, 1993: 1017-1032.
41.
Baker NT, Seager RD: A comparison of the psychosocial needs of hospice patients with AIDS and those with other diagnoses. Hospice J1991; 7(1/2), 61-69.
42.
Flaskerud JH: Psychosocial and psychiatric aspects. In: Flaskerud JH, P.J.Ungvarski PJ (eds.): HIV/AIDS: A guide to nursing care. Philadelphia: W.B. Saunders Company, 1995: 308-338.
43.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, 1994.
44.
McIver B, Walsh D, Nelson K: The use of chlorpromazine for symptom control in dying cancer patients. J Pain Symptom Manage1994; 9(5), 341-345.
45.
Doyle D: Have we looked beyond the physical and psychosocial?J Pain Symptom Manage1992; 5, 302-311.
46.
Dudley JR, Smith C, Millison MB: Unfinished business: Assessing the spiritual needs of hospice patients. Am J Hosp Pall Care1995; March/April, 30-37.
47.
Jung, CG: Psychology and alchemy. In: Jacobi J, Hull RFC (eds.): C.G. Jung: Psychological reflections. Princeton, New Jersey: Princeton University Press, 1953: 338-339.
48.
Pickard-Holley S: Fatigue in cancer patients. Ca Nursing1991; 14(1), 13-19.
49.
Hubsky EP, Sears JH: Fatigue in multiple sclerosis: Guidelines for nursing care. Rehab Nursing199217(4), 176-180.
50.
Hopewell PC, Masur H: Pneumocystis carinii pneumonia: Current concepts. In: Sande MA,Volberding PA (eds.): The medical management of AIDS (4th ed.). Philadelphia: W.B. Saunders Company, 1995: 367-401.
51.
Bruera E, Macmillan K, Pither J, Mac- Donald RN: Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage1990; 5 (6), 341-344.
52.
Cowcher K, Hanks GW: Long-term management of respiratory symptoms in advanced cancer. J Pain Symptom Manage1990; 5(5), 320-330.
53.
Elpern EH: Lung cancer. In: Groenwald SL, Frogge MH, Goodman M, Yarbro CH (eds.): Cancer nursing: Principles and practice. Boston: Jones and Bartlett, 1990: 951-973.
54.
Jones D, Molaghan JB: HIV nursing care. In: Sande MA, Volberding PA (eds.): The medical management of AIDS (4th ed.). Philadelphia: W.B. Saunders Company, 1995: 680-695.
55.
Polomano R, McEvoy MD: Nursing management of persons with progressive disease: Prototype-lung cancer. In: Baird SB, McCorkle R, Grant M (eds.): Cancer nursing: A comprehensive textbook. Philadelphia: W.B Saunders, 1991: 699-707.
56.
Zerwekh J: Supportive care of the dying patient. In: Baird SB, McCorkle R, Grant M (eds.): Cancer nursing: A comprehensive textbook. Philadelphia: W.B Saunders, 1991: 875-884.
57.
Atoner A, Onat H, Ozturk N, Aykan F, Inanc S, Topuz E, Dincol K: The efficacy of a five-drug antiemetic combination during chemotherapy regimens containing cisplatin or cyclophosphamide-doxorubin. J Pain Symptom Manage1993; 8(3), 126-131.
58.
Billings JA: The management of common symptoms. In: Billings JA (ed.): Outpatient management of advanced cancer. Philadelphia: J.B. Lippincott, 1985: 40-139.
59.
Grant M:Nausea, vomiting, and anorexia. Sem Oncology Nursing1987; 3(4), 277-286.
60.
Grant M, Ropka ME:Alterations in nutrition. In: Baird, SB, McCorkle R, Grant M (eds.): Cancer nursing: A comprehensive textbook. Philadelphia: W.B Saunders, 1991: 717-741.
61.
Kris, M.G. and Gralla, R.J. (1990). Management of vomiting caused by anticancer drugs. In K.M. Foley, J.J. Bonica, and V. Ventafridda (Eds.), Advances in pain research and therapy, Volume 16: Proceedings of the Second International Congress on Cancer Pain. (pp. 337-343). New York: Raven Press.
62.
Ouwekerk J, Keizer HJ:Psychologic aspects of the treatment of emesis in cancer nursing. Sem Oncology Nursing1990; 6(4), Supplement 1 (November), 6-9.
63.
Pervan V:Practical aspects of dealing with cancer therapy-induced nausea and vomiting. Sem Oncology Nursing1990; 6(4), Supplement 1 (November), 3-5.
64.
Mercadante S:Diarrhea in terminally ill patients: Diagnosis and treatment. J Pain Symptom Manage1995; 10(4), 298-309.
65.
Manfredi R, Vezzadini P, Costigliola P, Ricchi E, Pia Fanti M, Chiodo F:Elevated plasma levels of vasoactive intestinal peptide in AIDS patients with refractory idiopathic diarrhoea: Effects of treatment with octreotide. AIDS1993; 7(20, 223-226.
66.
La Brooy JT:Enteropathy in HIV infection. J Acquired Immune Deficiency Syndromes1993; 6(Supplement 1), s16-s19.
67.
Bruera E, Fainsinger RL:Clinical management of cachexia and anorexia. In: Doyle D, Hanks GWC, MacDonald N (eds.): Oxford textbook of palliative medicine. New York: Oxford University Press, 1993: 330-337.
68.
Nahlen BL, Chu SY, Nwanyanwu OC, Berkelman RL, Martinez SA, Rullan JV:HIV wasting syndrome in the United States. AIDS1993; 7(2), 183-188.
69.
Miller RJ, Albright PG:What is the role of nutritional support and hydration in terminal cancer patients. Am J Hosp Care; 1989; 6(6), 33-38.
70.
Waller A, Hershkowitz M, Adunsky A:The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients. Am J Hosp Pall Care1994; 11, 22-27
71.
Fainsinger RL, MacEachern T, Miller MJ, Bruera E, Spachynski K, Kuehn N, Hanson J: The use of hypodermoclysis for rehydration in terminally ill cancer patients. J Pain and Symptom Manage1994; 9,(5), 298-302.
