Palliative care for AIDS

challenges and opportunities in the era of highly active anti-retroviral therapy.

Peter A. Selwyn, Mimi Rivard

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

In contrast to the first decade of the AIDS epidemic, the past decade has seen an increasing separation between AIDS care and palliative care services. While this may be due in part to the perception that AIDS is no longer a uniformly fatal illness, AIDS in fact remains an important cause of morbidity and mortality for young adult populations in the United States, particularly among certain racial-ethnic minorities. Death rates have remained steady since the dramatic decreases noted in the mid-1990s, and causes of death now increasingly include co-morbidities such as hepatitis B, C, end-organ failure, and various malignancies. Moreover, as AIDS has been transformed into a more manageable, chronic disease in the era of 'highly active antiretroviral therapy' (HAART), the opportunities for palliative care interventions have only increased. Patients with AIDS continue to experience a high burden of pain and other chronic symptoms, over a longer period of time, with a disease course marked by more cumulative exacerbations and remissions than when AIDS was a stereotypic, rapidly fatal illness. Advance care planning and discussions of goals of care are more complex and involve more uncertainty than was the case when prognosis was clear-cut and treatment options were more limited. For all of these reasons, it is important for the distance which has developed between HIV and palliative care providers to be bridged. Contrary to popular perceptions, palliative medicine continues to have much to offer in the HAART era for the care of patients and families with HIV/AIDS, for whom treatment outcomes will only benefit from greater integration of disease-specific and palliative interventions. The challenge for care providers is now to implement successful strategies for integrating AIDS and palliative care services in all relevant clinical environments.

Original languageEnglish (US)
Pages (from-to)475-487
Number of pages13
JournalJournal of Palliative Medicine
Volume6
Issue number3
StatePublished - Jun 2003

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Palliative Care
Acquired Immunodeficiency Syndrome
Therapeutics
Highly Active Antiretroviral Therapy
Advance Care Planning
HIV
Patient Care Planning
Morbidity
Mortality
Hepatitis C
Hepatitis B
Chronic Pain
Uncertainty
Young Adult
Cause of Death
Patient Care
Chronic Disease
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Palliative care for AIDS : challenges and opportunities in the era of highly active anti-retroviral therapy. / Selwyn, Peter A.; Rivard, Mimi.

In: Journal of Palliative Medicine, Vol. 6, No. 3, 06.2003, p. 475-487.

Research output: Contribution to journalArticle

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