Palliative care for patients with acquired immunodeficiency syndrome

Kemp, Charles; Stepp, Lisa

doi:10.1177/104990919501200605

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…17,28,29 This discrepancy may be due in part to disparities in health insurance between HIV-infected and uninfected persons as uninsured patients are less likely to receive ICU-level care than patients with insurance. 30 For example, in one study, HIV-infected patients with PCP with Medicaid insurance were less likely to receive ICU care. 31 It is also possible that patients in rural areas have a higher threshold for seeking medical care and may present to hospital with more advanced illness compared to urban patients.…”

Section: Discussionmentioning

confidence: 99%

Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA

2015

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There are few data regarding outcomes from severe sepsis for HIV-infected patients living in rural or semi-rural settings. We aim to describe the characteristics and predictors of mortality in HIV-infected patients admitted with severe sepsis to the University of Virginia located in semi-rural Charlottesville, Virginia, USA. We queried the University of Virginia Clinical Data Repository for cases with ICD-9 codes that included: (1) infection, (2) acute organ dysfunction, and (3) HIV infection. We reviewed each case to confirm the presence of HIV infection and severe sepsis. We recorded socio-demographic, clinical, and laboratory data. We used a generalised linear mixed-effects model to assess pre-specified predictors of mortality. We identified 74 cases of severe sepsis in HIV-infected patients admitted to University of Virginia since 2001. The median (IQR) age was 44 (36-49), 32 (43%) were women, and 56 (76%) were from ethnic minorities. The median (IQR) CD4+ T-cell count was 81 (7-281) cells/µL. In-hospital mortality was 20%. When adjusted for severity of illness and respiratory failure, patients who lived >40 miles away from care or had a CD4+ T cell count <50 cells/µL had > four-fold increased risk of death compared to the rest of the study population (AOR = 4.18, 95% CI: 1.09-16.07, p = 0.037; AOR = 4.33, 95% CI: 1.15-16.29, p = 0.03). In HIV-infected patients from rural and semi-rural Virginia with severe sepsis, mortality was increased in those that lived far from University of Virginia or had a low CD4+ T cell counts. Our data suggest that rural HIV-infected patients may have limited access to care, which predisposes them to critical illness and a high associated mortality.

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Section: Discussionmentioning

confidence: 99%

Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA

2015

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“…In addition to antiemetic effects, reglan has substantial peripheral cholinergic effects that enhance gastric emptying. 22 Therefore, it is particularly useful in treating gastroparesis/GI motility disorders. 3 The effectiveness is limited by side effects which include acute dystonic reactions, akathisia and sedation.…”

Section: Managementmentioning

confidence: 99%

“…23 Caution should be taken with the above medications, as extrapyramidal side effects may be more pronounced in patients with AIDS in comparison to others suffering from nausea. 22 Cannabinoids such as marinol exert effects via the CNS through a mechanism not well understood. They have been found to have antiemetic effects when used alone or in conjunction with other medications.…”

Section: Managementmentioning

confidence: 99%

“…21 While ANV has not been studied in HIV research, the above strategies have been recommended for patients with HIV suffering from nausea and vomiting. 22…”

Section: Psychologicalmentioning

confidence: 99%

“…23 Caution should be taken with the above medications, as extrapyramidal side effects may be more pronounced in patients with AIDS in comparison to others suffering from nausea. 22…”

Section: Managementmentioning

confidence: 99%

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Nausea and vomiting in HIV: a symptom review

Chubineh

McGowan

2008

Int J STD AIDS

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Nausea and vomiting are two of the most common symptoms experienced by those with HIV. While the causes are most commonly attributed to medication side effects, infectious causes, gastroparesis and psychosomatic, therapy aimed at controlling symptoms has not been well studied. Since nausea and vomiting have been identified as the most common cause of discontinuation of highly active antiretroviral therapy (HAART) therapy, and due to the extensive morbidity associated with these symptoms, we sought to review and discuss causes and management of these symptoms in HIV-infected patients and demonstrate the need for further research in this area. Such studies could include investigation into the prophylactic use of antiemetics with initiation or modification of HAART therapy to monitor patient compliance. In addition, anticipatory nausea and vomiting should be further studied, as it could prove to be quite prevalent, as in cancer patients.

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Behandlung von Übelkeit und Erbrechen mit Prokinetika und Neuroleptika bei Palliativpatienten

Benze

Alt-Epping

Geyer

et al. 2012

Schmerz

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In patients with advanced cancer not being treated with chemotherapy or radiation therapy, metoclopramide can be used to reduce nausea and vomiting. Neuroleptics, such as levosulpiride or levomepromazine are alternatives but their adverse effects have to be considered carefully. The evidence level for prokinetics and neuroleptics is moderate to low. Concerning palliative care of patients with diseases other than cancer no studies exist. More well designed studies in palliative care patients are needed in order to facilitate evidence based antiemetic therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

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Palliative care for patients with acquired immunodeficiency syndrome

Cited by 8 publications

References 32 publications

Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA

Distance from care predicts in-hospital mortality in HIV-infected patients with severe sepsis from rural and semi-rural Virginia, USA

Nausea and vomiting in HIV: a symptom review

Behandlung von Übelkeit und Erbrechen mit Prokinetika und Neuroleptika bei Palliativpatienten

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