Ruiz Marco, Cefalu Charles
Section of Geriatric Medicine and Infectious Diseases, Louisiana State University-Health Sciences Center in New Orleans, New Orleans, LA, USA.
Am J Hosp Palliat Care. 2011 Feb;28(1):16-21. doi: 10.1177/1049909110371468. Epub 2010 Jun 11.
palliative care is extremely important for human immunodeficiency virus (HIV)-infected clientele. The impact of HIV infection is significant in the city of New Orleans. As of September 2009, a cumulative total of 29 548 HIV/acquired immunodeficiency syndrome (AIDS) cases and 12 267 HIV-related deaths were reported in Louisiana.
retrospective review of charts of patients enrolled in our palliative care program.
as of September 2009, there were around 1800 active patients in our HIV outpatient clinic. A total of 5 (22%) patients had multidrug-resistant AIDS infection. Three (13%) referred patients had AIDS dementia. Progressive multifocal leukoencephalopathy (PML) and advanced HIV nephropathy were also reasons for referral (13% and 4% of referred patients, respectively). Around 9% of patients had advanced liver cancer with metastases. In all, 22% of patients had rapidly deteriorating functional status. The rest of the patients (26%) complained of cancer-related nausea and vomiting and progressive and nonresponsive weight loss. In terms of psychosocial assessment, the majority of referred patients had problems in areas such as social functioning, mood swings, unstable moods, problems with controlling temper, outbursts of anger, violence, and disturbing or unreal thoughts and beliefs.
palliative care is extremely important in the care of patients with HIV/AIDS. More research is needed to elaborate on best palliative care practices in the care of HIV-infected patients. Interesting to note is that there is significant proportion of patients with mental issues (substance abuse, psychiatric problems, depression, and despair) for which better resources are needed. Integration of services among clinical, mental, and palliative care providers might be needed to better serve this population.
姑息治疗对感染人类免疫缺陷病毒（HIV）的患者极为重要。HIV感染在新奥尔良市的影响重大。截至2009年9月，路易斯安那州累计报告了29548例HIV/获得性免疫缺陷综合征（AIDS）病例以及12267例与HIV相关的死亡病例。
对纳入我们姑息治疗项目的患者病历进行回顾性研究。
截至2009年9月，我们的HIV门诊约有1800名活跃患者。共有5例（22%）患者患有耐多药AIDS感染。3例（13%）转诊患者患有AIDS痴呆症。进行性多灶性白质脑病（PML）和晚期HIV肾病也是转诊原因（分别占转诊患者的13%和4%）。约9%的患者患有伴有转移的晚期肝癌。总体而言，22%的患者功能状态迅速恶化。其余患者（26%）主诉有与癌症相关的恶心和呕吐以及进行性且无反应的体重减轻。在社会心理评估方面，大多数转诊患者在社交功能、情绪波动、情绪不稳定、情绪控制问题、愤怒爆发、暴力以及令人不安或不真实的想法和信念等方面存在问题。
姑息治疗在HIV/AIDS患者的护理中极为重要。需要更多研究来阐述HIV感染患者最佳姑息治疗实践。值得注意的是，有相当比例的患者存在精神问题（药物滥用、精神问题、抑郁和绝望），对此需要更好的资源。可能需要临床、精神和姑息治疗提供者之间整合服务，以便更好地服务这一人群。
