title: Palliative care for patients with HIV/AIDS admitted to intensive care units.
abstract: OBJECTIVE
  To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team.
  
  
  METHODS
  This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012.
  
  
  RESULTS
  Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit.
  
  
  CONCLUSIONS
  Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit.
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: Paola Nóbrega
authors.initials: PN
authors.lastname: Souza
authors.affiliation: Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Erique José Peixoto de
authors.initials: EJ
authors.lastname: Miranda
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: Ronaldo
authors.initials: R
authors.lastname: Cruz
authors.affiliation: Equipe de Cuidados Intensivos, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Daniel Neves
authors.initials: DN
authors.lastname: Forte
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D055815:Young Adult