As antiretroviral therapy has led to longer life expectancy among people living with HIV, the prevalence of aging-related and another comorbid disease has also increased in this population. A 2016 study, for example, projected a 44% increase in infection-unrelated malignancies over a 5-year period and a 28% reduction in infection-related malignancies.
Additionally, data show that cancer is the leading non-AIDS cause of death in people living with HIV, and this situation does not appear to be improving. The study was published in Lancet HIV.
According to a modeling study, 28% of individuals infected with HIV will have at least 3 comorbid noncommunicable diseases by 2030. “Lastly, the dying phase for people with HIV can cause enormous distress to their family members and caregivers” regarding emotional, financial, and social functioning.
Taken together, these issues underscore the need for palliative care in this population at various stages, including the end of life. In randomized controlled trials of palliative care in general, results demonstrated reductions in symptoms, in-hospital mortality, and cost, as well as improved physical and psychological functioning.
Although home palliative care and inpatient hospice care have been linked with improvements in pain and other symptoms, anxiety, and spiritual well-being among people with HIV, numerous barriers to such care have been noted.
Hospice Service Factors
These include service factors such as stigma within these settings, clinician factors including the conflict between disease-oriented and palliative care and fear of analgesia misuse, patient factors such as reluctance to address end-of-life issues, and disease factors including lack of predictable illness course.
Ironically, in the early days of HIV treatment, all care was in essence palliative care. However, the advent of [antiretroviral therapy] has arguably drawn focus away from the terminal care needs of people with HIV toward the behavioral and medical model of test-and-treat. Despite its demonstrated benefits and endorsement by the World Health Organization and the World Health Association, the availability of palliative care is lacking in one-third of countries.
Palliative Care Services
Noting the competency of existing specialist palliative care services in managing symptoms and concerns like those common in HIV, HIV-specific palliative care services might not be necessary if good teamwork between HIV physicians and palliative care teams can provide optimal treatment plans while minimizing polypharmacy.
By paying attention to palliative and end-of-life care needs among people with HIV, an appropriate and effective continuum of care is truly achievable.