Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008

ABSTRACT FORM

Presenting author THE NEED FOR PALLIATIVE CARE AMONG HIV-INFECTED PERSONS IN THE
HAART ERA
Fabrizio Palmieri
Email: Authors (max 6, presenting author included): Licordari R., Petrecchia A., Pellegrino A., Rosati
palmieri@inmi.it S., Iacomi F. Palmieri F.

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abstract
• Pain and other symptoms
• Palliative care for cancer patients
• Palliative care for non cancer
patients
• Paediatric palliative care
• Palliative care for the elderly
• The actors of palliative care
• Latest on drugs
• Pain
• Illness and suffering through
media
• Marginalisation and social stigma
at the end of life
• Palliative care advocacy projects
The use of highly active antiretroviral therapy (HAART) has significantly reduced AIDS-related
mortality in the developed world and has determined AIDS conversion from a rapidly fatal illness
into a manageable chronic disease. In the pre-HAART era, AIDS opportunistic infections (OI)
were the most common cause of death. Following the introduction of HAART in 1996 there was
an increasing proportion of deaths due to co-morbidities such as chronic hepatitis B and C and
concomitant malignancies (both AIDS- and non-AIDS defining), in addition to antiretroviral
treatment failure and HAART-related toxicities.
In order to evaluate causes of death and to identify its changes we retrospectively reviewed
clinical records of 353 HIV-infected patients who died at “L. Spallanzani” Institute between 1
January 2003 and 31 December 2007. 253 patients were AIDS cases and represent 14.6% of
1.727 AIDS deaths reported in Italy in the same period. At our Institute, in-hospital mortality rate
among HIV-infected patients declined from 6.9% in 2003 to 5.1% in 2007. When more than one
cause of death was found, the most likely underlying cause was scored independently by a panel
of three physicians until a final consensus was reached.
Causes of death were grouped into 6 categories and were as follows: AIDS OI 91 (25.8%), AIDS-
related malignancy 42 (11.9%), non-AIDS-related malignancy 35 (9.9%), hepatitis/liver-related
85 (24.1%), other infections 42 (11.9%), other/unknown causes 58 (16.4%).
In the HAART era, AIDS is a chronic, progressive disease that may be effectively managed in
many patients but it is still associated to a significant mortality. Death rates from non-AIDS-
related conditions, particularly hepatic failure and malignancy, may continue to rise in future
years as HIV-patients survive for longer. In this context, need for palliative care will become more
important in HIV infection, and both palliative and curative approaches should be more
considered throughout the course of HIV disease in the HAART era.

• Prognosis and diagnosis

communication in
different cultures
• Communication between doctor-
patient and patient-
equipe
• Religions and cultures versus
suffering, death and
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to metropolies

• Space, light and gardens for the

Session: Non cancer palliative care
terminally ill patient
• End-of-life ethics Chair of the session: Dott. M. Fantoni
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
• Rehabilitation in palliative care