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Palliative care and HIV, part II: systemic manifestations and late-stage issues.


 The last stages of HIV infection are marked by increasing pain, gastrointestinal discomfort, and depression. These conditions should be treated aggressively with restorative and prophylactic therapies. Patients who are bedridden or are suffering from an inflammatory or infiltrative process may suffer from somatic or visceral pain, which can be treated with analgesics. Patients with chronic pain and a history of narcotic abuse are not likely to develop addictions to opiates, and narcotics can be prescribed. Meanwhile, neuropathic pain, characterized as burning and tingling, is treated with tricyclic antidepressants and antiepileptic drugs. Also, depression, which affects up to 30 percent of HIV-positive patients, should be treated with the selective serotonin reuptake inhibitors. As a patient approaches death, talking with the patient, providing physical contact, and encouraging spiritual reflection can be beneficial. Current hospice care for AIDS patients needs to be improved, and palliation of the HIV disease should be predicated on patient preference, ease of administration, and minimization of side effects.
