Palliative care for patients with HIV/AIDS admitted to intensive care units

Abstract

ObjectiveTo 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.MethodsThis 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.ResultsOf 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.ConclusionPalliative 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.

Patterns of presentation and survival of HIV‐infected patients admitted to a tertiary‐level intensive care unit

“…HIV infection is a global health care problem, with over 38.8 million infected individuals , 2 million new cases annually and 1.2 million deaths per year . According to the Joint United Nations Programme on HIV and AIDS (UNAIDS) 2016 estimates, eastern and southern Africa were the world's most affected regions, with an estimate of 19.4 million people living with HIV in 2015 .…”

Management of nursing care in HIV/AIDS from a palliative and hospital perspective

“…Results from a study carried out at the Instituto de Infectologia Emílio Ribas (freely translated as Institute of Infectology Emílio Ribas) in São Paulo city show that of the 109 patients with HIV/AIDS hospitalized in the Intensive Care Unit between January 2006 and December 2012, 89% had reports of opportunistic diseases (predominantly tuberculosis), 70% had CD4 lower than 100 cels/mm3 and only 19% adhered to the treatment. The overall mortality rate was 88% (4) .…”

“…Although Highly Active Antiretroviral Therapy (HAART) decreases the likelihood of PLWHA disease and death, nonadherence to treatment is an alarming problem that contributes to the emergence of clinical complications of AIDS, such as opportunistic diseases. Consequently, this disease causes prolonged hospitalizations that compromise people's quality of life and expose them even more to nosocomial infections (1)(2)(3)(4)(5) .…”

“…Given the peculiarity of AIDS as a chronic, progressive, incurable condition that threatens the continuity of life, PLWHA palliative care is appropriate at any stage of infection, not only at the end of life (6) . However, in practice, palliative care, mainly due to the difficulty in achieving the prognosis and knowledge deficit of the health team on the subject, are implemented late, mainly in cases of patients with a high severity and mortality profile, with short survival, interfering in the level of use of the benefit of their actions for a good death and therapeutic proportions (4) .…”

“…The implementation of palliative care for PLWHA is permeated with complexities inherent in their experiences, often being affected by multiple comorbidities and submitted to polypharmacy, which results in an important functional decline (7)(8) . In the final phase of life, the implementation of palliative care can prevent therapeutic futility and contribute to beneficence, among other principles of bioethics; since the planning of their actions reflects a significant reduction in the use of blood products, antibiotics, prophylaxis against opportunistic diseases and HAART for patients already diagnosed at this stage, as well as the non-use of measures for prolonging life with artificial supports (4) .…”