oa SA Pharmaceutical Journal - Palliative care in advanced HIV : clinical
The natural course of untreated HIV / AIDS is characterised by a progressive deterioration of the underlying immune system, punctuated by consequent opportunistic infections and cancers. <BR>ART is the most effective palliation for HIV / AIDS so far. Patient care from the time of diagnosis should be multidisciplinary. Palliative care in AIDS is characterised by a higher proportion of extremely emotive issues surrounding sexuality, reproduction, guilt, loss of vitality, loss of productivity and death. <BR>Practical management of AIDS patients entails the formulation of individualised care plans for each patient and their families, drawn up by the multidisciplinary team in conjunction with the patient and family or caregivers. <BR>Symptoms in the terminal phase may be due to the HIV itself, treatment of HIV or opportunistic infections, associated debility or concomitant illness. Clinical care involves a detailed assessment to ascertain cause, followed by treatment of reversible causes, drug and non-drug palliation of chronic symptoms, and re-evaluation to assess response. <BR>Psychosocial care is facilitated by a family meeting involving relevant family members, with or without the patient, which allows for the transfer of information, education of the family on the patient's condition and for support on a practical and emotional level. <BR>Caring for terminally ill patients, especially young patients, can be a physically, psychologically and emotionally exhausting task, with which health care workers need to feel confident and comfortable, as personal fears and anxieties surrounding mortality are often conveyed to the patient. <BR>AIDS has provided a challenge to the medical fraternity at large, calling for closer collaboration between curative and palliative care, demanding that curative medicine adopts a higher level of care, and that palliative medicine adopt a reasonable measure of cure.
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