Patterns of pain medication use during last months of life in HIV-infected populations: the experience of an academic outpatient clinic.

INTRODUCTION: This article describes the patterns of use of pain medicines of HIV-infected patients during last months of life in an HIV university-affiliated outpatient clinic. METHODS: We retrospectively reviewed our databases and identified patients who died over the last 12 months in our clinic. Demographic, clinical, and laboratory information were abstracted. RESULTS: A total of 41 patients died in our HIV outpatient clinic in a period of 12 months. Opioid analgesics were prescribed for 21 (51%) patients, with 10 (48%) of these patients prescribed short-acting opioid analgesics alone, In all, 11 patients (52%) were on a short-acting and long-acting opioid combination, and 30 (73%) patients experienced pain that was not adequately controlled. DISCUSSION: Pain control during the last months of life for this population appears to be suboptimal. Better strategies are needed.

Antiretroviral therapy at the end of life: the experience of an academic HIV clinic.

INTRODUCTION: There are no guidelines regarding the discontinuation of antiretroviral therapy at the end of life. METHODS: We retrospectively reviewed our databases and identified patients with HIV/AIDS who died over the last 12 months in our HIV clinic. RESULTS: A total of 41 patients from our HIV clinic died in a period of 12 months. Seventy-three percent of the patients were on antiretroviral therapy during the last clinic visit. During the last 3 months of life, 32% (13 of 41) were off antiretroviral therapy, with 77% (10 of 13) of them having intermittent therapy due to noncompliance. The remaining 23% (3 of 13) decided to stop antiretroviral therapy after discussion among families, patients, and providers. CONCLUSION: Discussions among providers, patients, and families are encouraged to establish goals of care and role of antiretrovirals during the last months of life.