Palliative care and HIV management
Will palliative care become obsolete in the management of HIV? Evidence from the United Kingdom suggests not.
Even with widespread availability of antiretroviral drugs, a small number of infected people will still die of HIV-related conditions such as Non-Hodgkin's Lymphoma or from complications with weak immune systems due to treatment failure. High quality end-of-life care will always be required for these patients.
Those who receive and respond to antiretroviral (ARV) therapy have a high incidence of physical symptoms. Symptoms arise from HIV viral damage and associated diseases but also as side effects of ARVs. Symptoms must be addressed so that affected individuals can enjoy their improved life expectancy. If drug-related symptoms are not relieved then adherence to ARV therapy may be poor. Painful damage to the peripheral nervous system is common and debilitating. Nausea and diarrhoea frequently occur during ARV therapy and can result in treatment being stopped.
Individuals may respond well to ARV therapy but feel their quality of life is poor. Access to palliative care allows for holistic assessment and the possibility for some issues to be addressed. Working closely with the treatment team is essential to ensure complications are accurately diagnosed and that prescribed drugs do not interact badly with one another or harm the patient.
HIV services that focus on immunological control will inevitably not prioritise symptom control and holistic care. Providing palliative care alongside active treatment continues to be a priority for individuals with HIV, even where there is good access to effective antiretroviral therapy.
Sarah Cox
Chelsea and Westminster Hospital, 369 Fulham Road, London SW18 5AR, UK
T +44 (0) 20 82375054
F +44 (0) 20 87468863
sarah.cox@chelwest.nhs.uk
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