Palliative care program for human immunodeficiency virus-infected patients: rebuilding of an academic urban program.
BACKGROUND
palliative care is extremely important for human immunodeficiency virus (HIV)-infected clientele. The impact of HIV infection is significant in the city of New Orleans. As of September 2009, a cumulative total of 29 548 HIV/acquired immunodeficiency syndrome (AIDS) cases and 12 267 HIV-related deaths were reported in Louisiana.


METHODS
retrospective review of charts of patients enrolled in our palliative care program.


RESULTS
as of September 2009, there were around 1800 active patients in our HIV outpatient clinic. A total of 5 (22%) patients had multidrug-resistant AIDS infection. Three (13%) referred patients had AIDS dementia. Progressive multifocal leukoencephalopathy (PML) and advanced HIV nephropathy were also reasons for referral (13% and 4% of referred patients, respectively). Around 9% of patients had advanced liver cancer with metastases. In all, 22% of patients had rapidly deteriorating functional status. The rest of the patients (26%) complained of cancer-related nausea and vomiting and progressive and nonresponsive weight loss. In terms of psychosocial assessment, the majority of referred patients had problems in areas such as social functioning, mood swings, unstable moods, problems with controlling temper, outbursts of anger, violence, and disturbing or unreal thoughts and beliefs.


CONCLUSIONS
palliative care is extremely important in the care of patients with HIV/AIDS. More research is needed to elaborate on best palliative care practices in the care of HIV-infected patients. Interesting to note is that there is significant proportion of patients with mental issues (substance abuse, psychiatric problems, depression, and despair) for which better resources are needed. Integration of services among clinical, mental, and palliative care providers might be needed to better serve this population.
Ruiz
Marco
M
Section of Geriatric Medicine and Infectious Diseases, Louisiana State University-Health Sciences Center in New Orleans, New Orleans, LA, USA. mruiz@lsuhsc.edu
Cefalu
Charles
C
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000628:therapy*; D000328:Adult; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D055820:New Orleans; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult