Clinical Review

ABC of palliative care: HIV infection and AIDS

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7120.1433 (Published 29 November 1997) Cite this as: BMJ 1997;315:1433
  1. Chris G A Wood,
  2. Sally Whittet,
  3. Caroline S Bradbeer

    Introduction

    When AIDS first emerged as a clinical problem, some 15 years ago, many patients died early from acute illnesses such as pneumocystis carinii pneumonia. Cumulative experience and increased awareness have led to the use of prophylaxis, earlier diagnosis, and more effective treatments for HIV itself and the many complications of HIV infection and AIDS. As a result, patients with AIDS now have improved survival but are more likely to experience months or years of increasing dependency, punctuated by episodes of acute illness.

    View this table:

    Cases of AIDS and HIV infection in the United Kingdom*

    Currently, the clinical picture is changing through the use of new combinations of antiretroviral drugs, which improve patients' wellbeing and delay disease progression. They are not, however, a cure. Three drugs are usually used in combination, resulting in problems with drug interactions and compliance.

    Combination antiretroviral therapy

    • Responsible for decreased death rates, progression to AIDS, inpatient admissions

    • Dramatic physical and medical improvement in patients with apparently end stage AIDS

    • May help to control previously uncontrollable opportunistic infections and AIDS related symptoms

    • Benefits may be time limited, and therapeutic failure is increasingly common

    • Complex drug interactions, toxicities, and intolerance

    • Requires specialist management

    During the later stages of the disease many patients prefer to remain at home whenever possible, relying on the support of community services. Hospices are then used when residential respite care is needed. In addition, many patients have also been choosing to die at home or in a hospice rather than in hospital. This has meant that increasing numbers of people who are not specialists in HIV infection are needing to become familiar with managing HIV infection, especially in advanced or terminal cases.

    Some people with AIDS are very well informed about the illness and may also have experience of caring for partners and friends with AIDS. They can be …

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