The Palliative Care and Hospice for the People Living with HIV

Abstract

According to the advance of antiretroviral regimen and the early treatment strategy, people living with human immunodeficiency virus (PLWH) are achieving the goal of virologic suppression and immune restoration. Most of them no more die of acquired immunodeficiency syndrome (AIDS) defining illnesses, and become older with chronic comorbidities such as cardiovascular, metabolic, hepatic, renal and neurological diseases. However some PLWH still visit hospitals as late presenters with very low CD4＋ T cell counts, so that they suffer AIDS defining illnesses to die or experience severe neurological complications resulting in disabilities. Early palliative interventions are needed on the various symptoms of PLWH. Thus far chronic pains such as distal symmetric sensory polyneuropathies have been underevaluated. Active pain-relieving interventions are important to them. Recently we define end of life condition of human immunodeficiency virus (HIV) or eligibility to hospice care after adjusting current status of HIV treatment. Hospice teams should pay attention to the specific medical conditions, psychological needs, and social circumstances of PLWH. With just standard precautions as common infection control measures, general hospice cares can be provided to them like to other hospices subjects. For giving PLWH opportunities to have the end of life with value and dignity, hospice multidisciplinary team should intervene them early and aggressively. Now we need more clinical experiences and institutional improvements.

HIV-Related Stigma Reduction in the Era of Undetectable Equals Untransmittable: The South Korean Perspective

“…Considering South Korea’s extensive ART coverage, this proportion is alarming. These late presenters suffer from AIDS-defining illnesses and have a high risk of severe neurological complications resulting in disabilities [ 31 32 33 34 ]. Late presentation for HIV care is also a key marker of stigma manifestation: findings from a meta-analysis study identified that people who perceived high HIV-related stigma had twice the probability of late presentation than those who perceived low stigma [ 35 ].…”