To qualify for hospice, a patient with HIV must have a terminal prognosis as evidenced by:
CD4+ Count < 25 cells/mcL or persistent viral load > 100,000 copies/ml with on of the following:
- CNS lymphoma
- Untreated or not responsive to treatment wasting (loss of 33% lean body mass)
- Mycobacterium avium complex (MAC) bacteremia, untreated, unresponsive to treatment, or treatment refused
- Progressive multifocal leukoencephalopathy
- Systemic lymphoma with advanced HIV disease and partial response to chemotherapy
- Visceral Kaposis Sarcoma unresponsive to therapy
- Renal failure in absence of dialysis
- Cryptosporidium infection
- Toxoplasmosis unresponsive to therapy
- Decreased performance status, as measured by the Karnofsky Performance scale equal to or less than 50
The following are not required but support a referral:
- Chronic persistent diarrhea for one year
- Persistent serum albumin < 2.5
- Concomitant, active substance abuse
- Advanced AIDS Dementia complex
- Age > 50 years
- Toxoplasmosis
- Absence of antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease
- CHF symptomatic at rest