title: Characteristics of an ambulatory palliative care clinic for HIV-infected patients.
abstract: BACKGROUND
  Many HIV-infected patients in the current treatment era have substantial symptom burden, but few HIV palliative care clinics have been described. Our objective was to describe the University of Alabama at Birmingham (UAB) HIV palliative care clinic (HPCC) and compare it to the overall HIV clinic.
  
  
  METHODS
  We conducted a chart review of patients referred to the HPCC between April 2008 and June 2011. We evaluated the reason for referral and other issues addressed during palliative care visits. Patient Reported Outcome (PRO) data was used to assess depression (PHQ-9), anxiety (PHQ-A), and substance abuse (ASSIST).
  
  
  RESULTS
  Among 124 patients, mean age was 44 (range 27-64), and median CD4 count was 352 cells/mm(3) (IQR 209-639). Depression (43, 35%), anxiety (40, 32%), and current 8 (7%) or prior 68 (56%) substance abuse occurred at higher rates than in the overall HIV clinic (p<0.05). Pain was the most common reason for referral (118, 95%); most was chronic (113, 90%) and included back pain (26, 21%) and neuropathic pain (15, 12%). Other problems commonly addressed by the palliative team included nonpain symptoms such as depression (39, 48%) and anxiety (17, 21%), insomnia (25, 30%), and constipation (26, 32%).
  
  
  CONCLUSIONS
  This is the first description of a palliative care clinic embedded within an HIV primary care clinic in a developed country that sees patients at all stages of illness. Chronic pain and nonpain symptom management in patients with psychiatric and substance abuse comorbidities are important components of ambulatory palliative care for HIV-infected patients.
authors.affiliation: School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Perry
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molony
authors.forename: Rodney
authors.initials: R
authors.lastname: Tucker
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Merlin
mesh_terms: D000328:Adult; D000407:Alabama; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy