School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Palliat Med. 2013 Aug;16(8):934-7. doi: 10.1089/jpm.2012.0451. Epub 2013 Mar 11.
Many HIV-infected patients in the current treatment era have substantial symptom burden, but few HIV palliative care clinics have been described. Our objective was to describe the University of Alabama at Birmingham (UAB) HIV palliative care clinic (HPCC) and compare it to the overall HIV clinic.
We conducted a chart review of patients referred to the HPCC between April 2008 and June 2011. We evaluated the reason for referral and other issues addressed during palliative care visits. Patient Reported Outcome (PRO) data was used to assess depression (PHQ-9), anxiety (PHQ-A), and substance abuse (ASSIST).
Among 124 patients, mean age was 44 (range 27-64), and median CD4 count was 352 cells/mm(3) (IQR 209-639). Depression (43, 35%), anxiety (40, 32%), and current 8 (7%) or prior 68 (56%) substance abuse occurred at higher rates than in the overall HIV clinic (p<0.05). Pain was the most common reason for referral (118, 95%); most was chronic (113, 90%) and included back pain (26, 21%) and neuropathic pain (15, 12%). Other problems commonly addressed by the palliative team included nonpain symptoms such as depression (39, 48%) and anxiety (17, 21%), insomnia (25, 30%), and constipation (26, 32%).
This is the first description of a palliative care clinic embedded within an HIV primary care clinic in a developed country that sees patients at all stages of illness. Chronic pain and nonpain symptom management in patients with psychiatric and substance abuse comorbidities are important components of ambulatory palliative care for HIV-infected patients.
在当前的治疗时代，许多感染 HIV 的患者有很大的症状负担，但很少有 HIV 姑息治疗诊所被描述。我们的目的是描述阿拉巴马大学伯明翰分校（UAB）的 HIV 姑息治疗诊所（HPCC），并将其与整体 HIV 诊所进行比较。
我们对 2008 年 4 月至 2011 年 6 月期间转诊至 HPCC 的患者进行了病历回顾。我们评估了转诊的原因和姑息治疗就诊期间解决的其他问题。使用患者报告的结果（PRO）数据评估抑郁（PHQ-9）、焦虑（PHQ-A）和物质滥用（ASSIST）。
在 124 名患者中，平均年龄为 44 岁（范围 27-64 岁），中位 CD4 计数为 352 个细胞/mm³（IQR 209-639）。抑郁（43，35%）、焦虑（40，32%）和当前 8 例（7%）或以前 68 例（56%）物质滥用的发生率高于整体 HIV 诊所（p<0.05）。疼痛是最常见的转诊原因（118，95%）；大多数为慢性疼痛（113，90%），包括背痛（26，21%）和神经病理性疼痛（15，12%）。姑息治疗团队还常解决非疼痛症状，如抑郁（39，48%）和焦虑（17，21%）、失眠（25，30%）和便秘（26，32%）。
这是第一个在发达国家描述的将姑息治疗诊所嵌入到 HIV 初级保健诊所的描述，该诊所为所有疾病阶段的患者提供服务。在患有精神疾病和物质滥用合并症的 HIV 感染者中，慢性疼痛和非疼痛症状的管理是门诊姑息治疗的重要组成部分。
