Chapter 34 : Neurologic Aspects of Palliative Care for HIV/AIDS

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This chapter attempts to address the palliative-care issues that currently affect patients with HIV/AIDS and neurologic disease in many developed countries that have moved into the chronic-disease phase of the epidemic. The spectrum of morbidity and mortality in patients with AIDS has changed dramatically in recent years, following the advent of highly active antiretroviral therapy (HAART) in the mid-1990s. The chapter discusses the issues and the importance of incorporating a palliative care approach with respect to specific HIV-related neurologic conditions and symptoms. The current environment requires not only individual clinicians' sensitivity and expertise in dealing with the chronic symptom syndromes but also the institutional and programmatic response of the care delivery system in order to meet the needs effectively. While the chapter focuses on the palliative and supportive management of patients with HIV/AIDS with chronic neurologic disabilities and symptoms, it is important also to focus on care needs at the end of life for patients who die either of AIDS-related causes, of incurable comorbidities, or of other etiologies. In closing, it must be mentioned that the stresses and cumulative burden of caring for patients with AIDS in this chronic disease phase of the epidemic are also different from what they were earlier, when patients did not survive as long and there was a shorter shared history with their caregivers than is now the case.

Citation: Selwyn P, Booss J. 2009. Neurologic Aspects of Palliative Care for HIV/AIDS, p 489-497. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch34
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Treatment of pain: the WHO analgesic ladder. The guidelines for pain management are as follows:

Citation: Selwyn P, Booss J. 2009. Neurologic Aspects of Palliative Care for HIV/AIDS, p 489-497. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch34
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1. Anderson, K.,, and J. Mitchell. 2004. AIDS home- and community-based waivers: effects on use of services, expenditures, and survival. South. Econ. J. 71: 6077.
2. Centers for Disease Control. 1997. Update: trends in AIDS incidence, deaths, and prevalence--United States, 1996. Morb. Mortal. Wkly. Rep. 46: 165173.
3. Centers for Disease Control and Prevention. 2000. US HIV and AIDS cases reported through June 2000. HIV/AIDS Surv. Rep. 12 (2) : 144.
4. Chiasson, M. A.,, L. Berenson,, W. Li,, S. Schwartz,, T. Singh,, S. Forlenza,, B. A. Mojica, and, M. A. Hamburg. 1999. Declining HIV/AIDS mortality in New York City. J. Acquir. Immune Defic. Syndr. 21: 5964.
5. Curtis, J. R.,, and D. L. Patrick. 1997. Barriers to communication about end-of-life care in AIDS patients. J. Gen. Intern. Med. 12: 736741.
6. Curtis, J. R.,, D. L. Patrick,, E. Caldwell,, H. Greenlee, and, A. C. Collier. 1999. The quality of patient-doctor communication about end-of-life care: a study of patients with advanced AIDS and their primary care clinicians. AIDS 13: 11231131.
7. Curtis, J. R.,, D. L. Patrick,, E. S. Caldwell, and, A. C. Collier. 2000. Why don’t patients and physicians talk about end-of-life care? Arch. Intern. Med. 160: 16901696.
8. Doyle, D.,, G. W. C. Hanks, and, N. MacDonald (ed.). 1998. Oxford Textbook of Palliative Medicine, 2nd ed. Oxford University Press, New York, NY.
9. Egger, M.,, B. Hirschel,, P. Francioli,, P. Sudre,, M. Wirz,, M. Flepp,, M. Rickenbach,, R. Malinverni,, P. Vernazza, and, M. Battegay. 1997. Impact of new antiretroviral combination therapies on HIV-infected patients in Switzerland: prospective multicentre study. BMJ 315: 11941199.
10. Finucane, T. E.,, C. Christmas, and, K. Travis. 1999. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 282: 13651370.
11. Gillick, M. R. 2000. Rethinking the role of tube feeding in patients with advanced dementia. N. Engl. J. Med. 342: 206210.
12. Gilron, I.,, J. M. Bailey,, D. Tu,, R. R. Holden,, D. F. Weaver, and, R. L. Houlden. 2005. Morphine, gabapentin, or their combination for neuropathic pain. N. Engl. J. Med. 352: 13241334.
13. Harrison, L. H.,, B. Vaz,, D. M. Taveira,, T. C. Quinn,, C. J. Gibbs,, S. H. de Souza,, J. C. McArthur, and, M. Schechter. 1997. Myelopathy among Brazilians coinfected with human T-cell lymphotropic virus type 1 and HIV. Neurology 48: 1318.
14. Hellinger, F. J. 2007. The changing pattern of hospital care for persons living with HIV: 2000 through 2004. J. Acquir. Immune Defic. Syndr. 45: 239246.
15. Jacox, A.,, D. B. Carr, and, R. Payne. 1994. Clinical Practice Guideline: Management of Cancer Pain. AHCPR Publication no. 93-0595. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, Rockville, MD.
16. Kravcik, S.,, N. Hawley-Foss,, G. Victor,, J. B. Angel,, G. E. M. Garver,, S. Page,, N. Denomme,, L. O’Reilly, and, D. W. Cameron. 1997. Causes of death in HIV-infected persons in Ottawa, Ontario, 1984-1995. Arch. Intern. Med. 157: 20692073.
17. Louie, J. K.,, L. C. Hsu,, D. H. Osmond,, M. H. Katz, and, S. K. Schwarcz. 2002. Trends in causes of death among persons with acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy, San Francisco, 1994-1998. J. Infect. Dis. 186: 10231027.
18. Mayor, A. M.,, M. A. Gomez,, D. M. Fernandez,, E. Rios-Olivares,, J. C. Thomas, and, R. F. Hunter. 2006. Morbidity and mortality profile of human immunodeficiency virus-infected patients with and without hepatitis C co-infection. Am. J. Trop. Med. Hyg. 74: 239245.
19. McArthur, J. C.,, N. Haughey,, S. Gartner,, K. Conant,, C. Pardo,, A. Nath, and, N. Sacktor. 2003. Human immunodeficiency virus-associated dementia: an evolving disease. J. Neurovirol. 9: 205221.
20. Norval, D. A. 2004. Symptoms and sites of pain experienced by AIDS patients. S. Afr. Med. J. 94: 450454.
21. Ogbuokiri, J. 2003. Pharmacologic interactions of HIV and palliative medications, p. 549–586. In J. F. O’Neill,, P. A. Selwyn, and, H. Scheitinger (ed.), A Clinical Guide to Supportive and Palliative Care for HIV/AIDS. Health Resources and Services Administration, Rockville, MD.
22. O’Neill, J. F., P. A. Selwyn, and, H. Scheitinger (ed.). 2003. A Clinical Guide to Supportive & Palliative Care for HIV/AIDS. Health Resources and Services Administration, Rockville, MD.
23. Palella, F. A., Jr.,, K. M. Delaney,, A. C. Moorman,, M. O. Loveless,, J. Fuhrer,, G. A. Satten,, D. J. Aschman, and, S. D. Holmberg. 1998. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N. Engl. J. Med. 338: 853860.
24. Piscitelli, S. C.,, and K. D. Gallicano. 2001. Drug therapy: interactions among drugs for HIV and opportunistic infections. N. Engl. J. Med. 344: 984996.
25. Puoti, M.,, A. Spinetti,, A. Ghezzi,, F. Donato,, S. Zaltron,, V. Putzolu,, E. Quiros-Roldan,, B. Zanini,, S. Casari, and, G. Carosi. 2000. Mortality from liver disease in patients with HIV infection: a cohort study. J. Acquir. Immune Defic. Syndr. 24: 211217.
26. Rabkin, J. G.,, M. McElhiney,, R. Rabkin, and, S. J. Ferrando. 2004. Modafinil treatment for fatigue in HIV+ patients: a pilot study. J. Clin. Psychiatry 65: 16881695.
27. Sacktor, N. 2002. The epidemiology of human immunodeficiency virus-associated neurological disease in the era of highly active antiretroviral therapy. J. Neurovirol. 8 (Suppl. 2) : S115S121.
28. Sacktor, N. C.,, R. L. Skolasky,, R. H. Lyles,, D. Esposito,, O. A. Selnes, and, J. C. McArthur. 2000. Improvement in HIV-associated motor slowing after antiretroviral therapy. J. Neurovirol. 6: 8488.
29. Sansone, R. G.,, and J. D. Frengley. 2000. Impact of HAART on causes for death of persons with late-stage AIDS. J. Urban Health 77: 166175.
30. Selwyn, P. A.,, J. L. Goulet,, S. Molde,, J. Constantino,, K. P. Fennie,, P. Wetherill,, D. M. Gaughan,, H. Brett-Smith, and, C. Kennedy. 2000. HIV as a chronic disease: long-term care for patients with HIV at a dedicated skilled nursing facility. J. Urban Health 77: 187203.
31. Selwyn, P. A.,, and M. Rivard. 2003. Palliative care for AIDS: challenges and opportunities in the era of highly active antiretroviral therapy. J. Palliat. Med. 6: 475487.
32. Singer, P. A.,, D. K. Martin,, J. V. Lavery,, E. C. Thiel,, M. Kelner, and, D. C. Mendelssohn. 1998. Reconceptualizing advance care planning from the patient’s perspective. Arch. Intern. Med. 158: 879884.
33. Singer, P. A.,, E. C. Thiel,, I. Salit,, W. Flanagan, and, D. Naylor. 1997. The HIV-specific advance directive. J. Gen. Intern. Med. 12: 729735.
34. U.S. Department of Health and Human Services. 10 October 2006. Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents. U.S. Department of Health and Human Services, Washington, DC.
35. Valcour, V.,, C. Shikuma,, B. Shiramizu,, M. Watters,, P. Poff,, O. Selnes,, P. Holck,, J. Grove, and, N. Sacktor. 2004. Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort. Neurology 63: 822827.
36. Valdez, H.,, T. K. Chowdhry,, R. Asaad,, I. J. Woolley,, T. Davis,, R. Davidson,, N. Beinker,, B. M. Gripshover,, R. A. Salata,, G. McComsey,, S. E. Weissman, and, M. M. Lederman. 2001. Changing spectrum of mortality due to HIV: analysis of 260 deaths during 1995-1999. Clin. Infect. Dis. 32: 14871493.
37. Voltz, R.,, J. D. Bernat,, G. D. Borasio,, I. Maddocks,, D. Oliver, and, R. K. Portenoy. 2004. Palliative Care in Neurology. Oxford University Press, London, United Kingdom.
38. Watters, M. R.,, P. W. Poff,, B. T. Shiramizu,, P. S. Holck,, K. M. Fast,, C. M. Shikuma, and, V. G. Valcour. 2004. Symptomatic distal sensory polyneuropathy in HIV after age 50. Neurology 62: 13781383.
39. Wenger, N. S.,, D. E. Kanouse,, R. L. Collins,, H. Liu,, M. A. Schuster,, A. L. Gifford,, S. A. Bozzette, and, M. F. Shapiro. 2001. End-of-life discussions and preferences among persons with HIV. JAMA 285: 28802887.
40. World Health Organization. 1990. Cancer Pain Relief and Palliative Care. Report of a WHO Expert Committee. Publication 1100804. World Health Organization, Geneva, Switzerland.


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Medications used for palliative treatment of common symptoms in HIV/AIDS

Citation: Selwyn P, Booss J. 2009. Neurologic Aspects of Palliative Care for HIV/AIDS, p 489-497. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch34

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