HIV/AIDS: Past, Present, and Future (330): HIV SIG

Abstract

1.Describe the changing epidemiology of HIV in the U.S.2.Identify HIV-infected patients who will benefit from hospice and palliative care.3.Recognize the role of hospice and palliative care in treating patients with HIV in the current antiretroviral era. Prior to the introduction of highly active antiretroviral treatment (HAART) in 1996, HIV-infected patients often suffered from serious life limiting opportunistic infections and required hospice services. In the current treatment era, the epidemiology of HIV disease has changed significantly. Patients now live long, relatively healthy lives. However, they accumulate comorbidities faster and at a younger age than non-HIV-infected patients, and have high rates of pain and symptoms. Not only do HIV-infected patients age prematurely, but the population of HIV-infected patients in the U.S. is also aging. As a result, the role of hospice and palliative care services in HIV positive patients is changing. The objective of this session is to use a case-based approach to provide a historic perspective on the role that hospice and palliative care programs play in the care of patients with HIV. The first case will describe a patient in the pre-HAART era presenting to hospice care with advanced AIDS and will highlight the physical and psychosocial challenges these patients confronted. The second case will describe a contemporary patient on combination antiretroviral therapy with an undetectable viral load and high CD4 cell counts. This patient has comorbid psychiatric illness, cardiovascular disease, diabetes, and hypertension, and presents with chronic pain. The major causes of mortality and morbidity in HIV positive patients in the current era will be discussed. Finally, we will describe what role hospice and palliative care programs will play as the epidemiology of patients with HIV continues to change, and the HIV-infected patient population accumulates more comorbidities and ages.