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Palliative care: Issues in HIV/AIDS in adults

Jessica Merlin, MD
Meera Pahuja, MD
Peter A Selwyn, MD, MPH
Section Editor
R Sean Morrison, MD
Deputy Editors
Diane MF Savarese, MD
Allyson Bloom, MD


Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients facing serious illness and their families. The primary tenets are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and caregivers; and psychosocial, spiritual, and practical support, both to patients and their caregivers. For patients with a variety of advanced illnesses, palliative care is applicable early in the course of the disease in conjunction with disease-modifying therapies (the simultaneous care model); it is not limited to end of life care [1]. (See "Benefits, services, and models of subspecialty palliative care", section on 'Rationale for palliative care'.)

In the early days of the human immunodeficiency virus (HIV) epidemic, all care for individuals with HIV-related disease was, by definition, palliative. With the introduction of tolerable, effective antiretroviral therapy (ART), HIV infection was transformed from a terminal disease with a uniformly poor prognosis to a serious chronic illness, at least in resource-rich settings among individuals who know their HIV status and are adherent to ART [2]. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient" and "The natural history and clinical features of HIV infection in adults and adolescents".)

However, even in the modern treatment era, individuals with HIV fit well within the “serious illness” paradigm for which early integration of palliative care plays a complementary role to active treatment of the underlying disease. These patients have a substantial burden of medical and psychiatric comorbidities, pain, and other symptoms throughout the course of the disease, and a wide-ranging need for psychosocial, family, and care-planning support. Although no studies have investigated this to date, it is possible that treatment of these comorbidities could improve HIV outcomes, such as adherence to ART, retention in HIV primary care, and virologic suppression.

This topic review describes an approach to palliative care in patients with HIV/acquired immunodeficiency syndrome (AIDS) in resource-rich settings that is based on the available literature and our clinical experience. The specific areas in which palliative care principles and expertise might assist in the care of individuals with HIV infection include establishing goals of care, advance care planning, making decisions about continuing or discontinuing ART as the end of life approaches, and symptom management.


HIV infection can be divided into the following stages:


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