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Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence
  1. R Harding1,
  2. D Karus2,
  3. P Easterbrook3,
  4. V H Raveis2,
  5. I J Higginson1,
  6. K Marconi4
  1. 1Department of Palliative Care and Policy, Guy’s King’s and St Thomas’s School of Medicine, King’s College, London, UK
  2. 2Center for the Psychosocial Study of Health and Illness, Mailman School of Public Health, Columbia University
  3. 3Academic Department of HIV and GU Medicine, Guy’s King’s and St Thomas’s School of Medicine, King’s College, London, UK
  4. 4HIV/AIDS Bureau, Health Resources and Services Administration, US Department of Health and Human Services
  1. Correspondence to:
 Dr Richard Harding


Background: The need for palliative care in HIV management is underlined by the high prevalence of pain and symptoms, the toxicity, side effects, and virological failure associated with antiretroviral therapy, emergence of co-morbidities, continued high incidence of malignancies, late presentation of people with HIV disease, and the comparatively higher death rates among the infected individuals.

Methods: A systematic review was undertaken to appraise the effect of models of palliative care on patient outcomes. A detailed search strategy was devised and biomedical databases searched using specific terms relevant to models of palliative care. Data from papers that met the inclusion criteria were extracted into common tables, and evidence independently graded using well described hierarchy of evidence.

Results: 34 services met the inclusion criteria. Of these, 22 had been evaluated, and the evidence was graded as follows: grade 1 (n = 1); grade 2 (n = 2); grade 3 (n = 7); grade 4 (n = 1); qualitative (n = 6). Services were grouped as: home based care (n = 15); home palliative care/hospice at home (n = 7); hospice inpatient (n = 4); hospital inpatient palliative care (n = 4); specialist AIDS inpatient unit (n = 2); and hospital inpatient and outpatient care (n = 2). The evidence largely demonstrated that home palliative care and inpatient hospice care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, insight, and spiritual wellbeing.

Conclusions: Although the appraisal of evidence found improvements across domains, the current body of evidence suffers from a lack of (quasi) experimental methods and standardised measures. The specialism of palliative care is responding to the clinical evidence that integration into earlier disease stages is necessary. Further studies are needed to both identify feasible methods and evaluate the apparent beneficial effect of palliative care on patient outcomes in the post-HAART era.

  • CCT, community care team
  • HAART, highly active antiretroviral therapy
  • HCA, home care assistance
  • HST, home support team
  • ITDU, infectious and tropical diseases unit
  • PCU, palliative care unit
  • POS, Palliative Outcome Scale
  • QoL, quality of life
  • RCT, randomised controlled trial
  • STAS, Support Team Assessment Schedule
  • HIV
  • palliative care
  • systematic review

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