HIV - For Physicians
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
HIV - For Families
When is is time for end-stage HIV hospice care?
Answering these questions may serve as a guide:
- Have you (or a loved one) developed a serious comorbid illness such as cervical cancer, lymphoma or heart disease?
- Do you (or a loved one) have a low CD4 count and high viral loads, with poor compliance with antiviral therapy?
- Have you (or a loved one) been repeatedly hospitalized every few months for the same problem and no longer wish to be hospitalized?
- Are you (or your loved one) ready to seek “aggressive comfort care” instead of aggressive treatment?
If you answered “yes” to these questions, now may be an appropriate time to discuss Community Hospice with your physician or one of our clinical professionals. Feel free to call us directly at (251) 943-5015.