Palliative Care for People with HIV

As effective treatment options for HIV have evolved and AIDS-related mortality declines, people are able to live longer with HIV. Thus, with the increasing uptake of antiretroviral treatment, the burden of disease for people living with HIV has shifted from acute treatment of AIDS-defining illnesses and end-of-life care to management of chronic diseases associated with aging. Physical, psychological, social and spiritual burden related to HIV, treatment, and complex comorbidities can have an immense impact on the quality of life of patients and their families, particularly in low- and middle-income countries where health systems provision might be limited. Even so, stigma and discrimination against people living with HIV can be a barrier to appropriate delivery and uptake of services. Significant evidence supports the expansion of palliative care for people living with HIV, particularly key populations such as men who have sex with men, sex workers, and transgender persons. Palliative care has been shown to significantly improve pain and symptom control, quality of life and stigma and reduce healthcare utilization. As such, a person-centred approach to HIV care is necessary to mitigate the severe clinical, public health, economic, and ethical implications of uncontrolled symptoms and lack of advance care planning. To reflect this need, multinational guidance now recommends palliative care provision for people living with HIV.